Methods and compositions for lowering the level of tumor necrosis factor (TNF) in TNF-associated disorders

ABSTRACT

The present invention provides recombinant adeno-associated virus (rAAV) vectors encoding a tumor necrosis factor (TNF) antagonist and methods using these vectors to reduce levels of TNF in a mammal. The invention also provides methods of using these rAAV vectors in palliating TNF-associated disorders.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.10/314,033, filed on Dec. 6, 2002, which is a continuation of U.S.patent application Ser. No. 09/579,845, filed on May 26, 2000, now U.S.Pat. No. 6,537,540, which claims the benefit of U.S. provisional patentapplication Ser. No. 60/150,688, filed on May 28, 1999, the contents ofeach of which are incorporated herein by reference in their entirety.

STATEMENT OF RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSOREDRESEARCH

(Not Applicable)

FIELD OF INVENTION

This invention relates to the use of adeno-associated virus (AAV)vectors to lower levels of tumor necrosis factor (TNF). Morespecifically, the invention relates to AAV vectors encoding a TNFantagonist and methods of using the AAV vectors to reduce the levels ofTNF in an individual.

BACKGROUND

Tumor necrosis factor-α (TNFα) and tumor necrosis factor-β (TNFβ) arehomologous multifunctional cytokines; the great similarities instructural and functional characteristics of which have resulted intheir collective description as tumor necrosis factor or “TNF.”Activities generally ascribed to TNF include: release of other cytokinesincluding IL-1, IL-6, GM-CSF, and IL-10, induction of chemokines,increase in adhesion molecules, growth of blood vessels, release oftissue destructive enzymes and activation of T cells. See, for example,Feldmann et al., 1997, Adv. Immunol., 64:283-350, Nawroth et al., 1986,J. Exp. Med., 163:1363-1375; Moser et al., 1989, J. Clin. Invest.,83:444-455; Shingu et al., 1993, Clin. Exp. Immunol. 94:145-149; MacNaulet al., 1992, Matrix Suppl., 1:198-199; and Ahmadzadeh et al., 1990,Clin. Exp. Rheumatol. 8:387-391. All of these activities can serve toenhance an inflammatory response.

TNF initiates its biological effect through its interaction withspecific, cell surface receptors on TNF-responsive cells. There are twodistinct forms of the cell surface tumor necrosis factor receptor(TNFR), designated p75 (or Type II) and p55 (or Type I) (Smith et al.,1990, Science 248:1019-1023; Loetscher et al., 1990, Cell 61:351-359).TNFR Type I and TNFR Type II each bind to both TNFα and TNFβ. Soluble,truncated versions of the TNFRs with a ligand-binding domain are presentin body fluids and joints (Engelmann et al., 1989, J. Biol. Chem.264:11974-11980; Roux-Lombard et al., 1993, Arthritis Rheum.36:485-489).

A number of disorders are associated with elevated levels of TNF, manyof them of significant medical importance. Among such TNF-associateddisorders are congestive heart failure, inflammatory bowel diseases(including Crohn's disease), arthritis and asthma.

TNF appears to effect the heart and endothelium in congestive heartfailure and has been implicated in the initiation of an apoptoticprocess in cardiac myocytes. The role for TNF in this disease is alsosupported by a temporal association between TNF activation and atransition from asymptomatic to symptomatic congestive heart failure(Ceconi et al., 1998, Prog. Cardiovasc. Dis. 41:25-30).

Inflammatory bowel diseases, such as Crohn's disease and ulcerativecolitis, are associated with increased expression of TNF (Evans et al.,1997, Aliment. Pharmacol. Ther. 11:1031-1035). Treatment of suchdisorders have included the widespread use of immunosuppressive agents,such as azathioprine, methotrexate, cyclosporine andglucocorticosteroids (Rutgeerts, 1998, Digestion 59:453-469).

Arthritis is a common crippling condition for which there are no curesand few effective therapies. Approximately one in seven people in theUnited States are affected by one or more forms of arthritis. Most formsof arthritis are characterized by chronic inflammation of jointsresulting from infection, mechanical injury, or immunologicaldisturbance. Rheumatoid arthritis (RA) is a chronic inflammatory diseaseprimarily manifest in the joints by swelling, pain, stiffness, andtissue destruction (Harris, 1990, N. Engl. J. Med, 323:994-996).Systemic manifestations can include elevations in serum levels of acutephase proteins, fever, mild anemia, thrombocytosis, and granulocytosis.In affected joints, there is a synovitis characterized by hyperplasiaand inflammation of the synovium with an inflammatory exudate into thejoint cavity, leading to erosion of cartilage and bone.

Although rheumatoid arthritis is not directly and imminently lifethreatening, recent data suggest that RA results in significantlyshorter lifespan, and puts an enormous toll on the both the healthsystem, the overall economy due to lost productivity, as well as qualityof life resulting from restricted mobility and activities (Schiff, 1997,Am. J. Med., 102(1A):11S-15S).

Current commonly employed therapeutics for treatment of RA fallprimarily in three categories: non-steroidal anti-inflammatory drugs(NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), andimmunosuppressives. NSAIDs are a large group of drugs often used asfirst line therapy for rheumatoid arthritis. The compounds act primarilythrough blockade of cyclooxygenase which catalyzes conversion ofarachidonic acid to prostaglandins and thromboxanes. As a class, DMARDs,including agents such as gold, sulfasalazine, hydroxychloroquine, andD-penicillamine, are slow acting, quite toxic and there is littleevidence that any of these compounds have mitigating effects on theunderlying disease. NSAIDs can relieve some of the signs of inflammationand pain associated with arthritis; however, they appear to beineffective against the immune system and in blocking progression ofjoint destruction and disease. Immunosuppressive agents, such ascorticosteroids and methotrexate, are commonly used in the treatment ofRA for suppressing the immune system and thus having ananti-inflammatory effect. However, these agents engender serioussystemic toxicity which limits their use and effectiveness.

Although it is widely accepted that RA is an immune-based inflammatorydisease, the antigen(s) which trigger the disease remain unknown. Thishas led to a large number of approaches to therapy under pre-clinical orclinical investigation which involve attempts to modulate the immuneresponse system as a whole. Examples of several general efforts in thisdirection are highlighted below.

The mechanism of action of NSAIDs has been linked to blocking ofcyclooxygenase, an enzyme with both an inducible and a constitutiveform. As the inducible form of cyclooxygenase appears to be elevated ininflammatory disease, investigation into compounds selective for theinducible form are underway. In addition, attempts to devise vaccines totreat ongoing arthritis have been made with the use of peptide vaccinesdirected toward MHC class II or T cell receptor proteins. Generally, ithas been proven difficult to demonstrate efficacy of vaccinesadministered to ongoing disease.

Much of the tissue destruction in RA appears to be due to variousmetalloproteinases. This group of proteases are believed to be centralto the degradation of collagen II and proteoglycan seen in arthritis. Anumber of inhibitors of various of these enzymes are under pre-clinicalor clinical investigation.

A number of broadly immunosuppressive drugs are in clinical testing foruse in rheumatoid arthritis, including cyclosporine A and mycophenolatemofetil. As a wide range of cytokines are found in arthritic joints,anti-arthritis therapies have targeted cytokine pathways including thoseof IL-1, IL-2, IL-4, IL-10, IL-11, TGFβ, and TNFα, as well as, chemokinepathways (Feldmann et al., 1997). In particular, proinflammatorypathways of IL-1 have been targeted both by attack of IL-1 directly andvia the naturally occurring interleukin-1 receptor antagonist molecule.

Methods of administering drug therapy for RA have included, and havebeen proposed to include, systemic or local delivery of a therapeuticdrug and, in the case of proposed gene therapies, of a therapeutic gene.To date, such treatments have fallen short of delivering effective, safetherapy for arthritis for a variety of reasons, including: systemic sideeffects of many drugs, rapid clearance of therapeutic molecules frominjected joints and/or circulation, inefficiency in DNA integration andexpression from the genome, limited target cell population associatedwith some viral delivery vectors, transient gene expression associatedwith viral vectors which do not readily integrate and induction of animmune response associated with the gene delivery virus.

Use of TNF antagonists, such as soluble TNFRs and anti-TNF antibodies,has shown that a blockade of TNF can reverse effects attributed to TNFincluding decreases in IL-1, GM-CSF, IL-6, IL-8, adhesion molecules andtissue destruction (Feldmann et al., 1997). Such pleiotropic effectsapparently due to the blockade of TNF alone suggests that TNF may lienear the top of the cascade of cytokine mediated events. Elevated levelsof TNF-α are found in the synovial fluid of RA patients (Camussi andLupia, 1998, Drugs 55:613-620).

The effect of TNF blockade utilizing a hamster anti-mouse TNF antibodywas tested in a model of collagen type II arthritis in DBA/1 mice(Williams et al., 1992, Proc. Natl. Acad. Sci. USA, 89:9784-9788).Treatment initiated after the onset of disease resulted in improvementin footpad swelling, clinical score, and histopathology of jointdestruction. Other studies have obtained similar results using eitherantibodies (Thorbecke et al., 1992, Proc. Natl. Acad. Sci. USA,89:7375-7379) or TNFR constructs (Husby et al., 1988, J. Autoimmun.1:363-71; Tetta et al., 1990, Ann. Rheum. Dis. 49:665-667; Wooley etal., 1993, J. Immunol. 151:6602-6607; Piguet et al., 1992, Immunology77:510-514).

Similar results have also been obtained in other animal models ofongoing arthritis. In the rabbit, anti-TNFα antibody was shown to havean anti-arthritic effect on antigen induced arthritis (Lewthwaite etal., 1995, Ann. Rheum. Dis. 54:366-374). In the rat, anti-TNF therapyhas been demonstrated to be effective in adjuvant (Mycobacterium)arthritis (Issekutz et al., 1994, Clin. Exp. Immunol. 97:26-32), instreptococcal cell wall induced arthritis (Schimmer et al., 1997, J.Immunol. 159:4103-4108) and in collagen induced arthritis (Le et al.,1997, Arthritis Rheum. 40:1662-1669).

In the studies described above, the TNF blockade was achieved bysystemic delivery of the blocking agent. In a rat collagen arthritismodel, delivery of a TNFR gene using an adenoviral vector resulted intransient production of serum levels of TNFR (up to 8 days) and asignificant decrease in disease progression when the adenovirus wasgiven to animals undergoing active arthritis (Le et al., 1997). Attemptsto deliver the gene directly to the joint were unsuccessful, however,and resulted in an inflammatory reaction to the adenovirus.

A monoclonal antibody directed against TNFα (infliximab, REMICADE,Centocor), administered with and without methotrexate, has demonstratedclinical efficacy in the treatment of RA (Elliott et al., 1993,Arthritis Rheum. 36:1681-1690; Elliott et al., 1994, Lancet344:1105-1110). These data demonstrate significant reductions in Paulus20% and 50% criteria at 4, 12 and 26 weeks. This treatment isadministered intravenously and the anti-TNF monoclonal antibodydisappears from circulation over a period of two months. The duration ofefficacy appears to decrease with repeated doses. The patient cangenerate antibodies against the anti-TNF antibodies which limit theeffectiveness and duration of this therapy (Kavanaugh et al., 1998,Rheum. Dis. Clin. North Am. 24:593-614). Administration of methotrexatein combination with infliximab helps prevent the development ofanti-infliximab antibodies (Maini et al., 1998, Arthritis Rheum.41:1552-1563). Infliximab has also demonstrated clinical efficacy in thetreatment of the inflammatory bowel disorder Crohn's disease (Baert etal., 1999, Gastroenterology 116:22-28).

Clinical trials of a recombinant version of the soluble human TNFR (p75)linked to the Fc portion of human IgG1 (sTNFR(p75):Fc, ENBREL, Immunex)have shown that its administration resulted in significant and rapidreductions in RA disease activity (Moreland et al., 1997, N. Eng. J.Med., 337:141-147). In addition, preliminary safety data from an ongoingpediatric clinical trial for sTNFR(p75):Fc indicates that this drug isgenerally well-tolerated by patients with juvenile rheumatoid arthritis(JRA) (Garrison et al, 1998, Am. College of Rheumatology meeting, Nov.9, 1998, abstract 584).

As noted above, ENBREL is a dimeric fusion protein consisting of theextracellular ligand-binding portion of the human 75 kilodalton (p75)TNFR linked to the Fc portion of human IgG1. The Fc component of ENBRELcontains the CH2 domain, the CH3 domain and hinge region, but not theCH1 domain of IgG1. ENBREL is produced in a Chinese hamster ovary (CHO)mammalian cell expression system. It consists of 934 amino acids and hasan apparent molecular weight of approximately 150 kilodaltons (Smith etal., 1990, Science 248:1019-1023; Mohler et al., 1993, J. Immunol.151:1548-1561; U.S. Pat. No. 5,395,760 (Immunex Corporation, Seattle,Wash.); U.S. Pat. No. 5,605,690 (Immunex Corporation, Seattle, Wash.).

Approved by the Food and Drug administration (FDA) (Nov. 2, 1998),ENBREL is currently indicated for reduction in signs and symptoms ofmoderately to severely active rheumatoid arthritis in patients who havehad an inadequate response to one or more disease-modifyingantirheumatic drugs (DMARDs). ENBREL can be used in combination withmethotrexate in patients who do not respond adequately to methotrexatealone. ENBREL is also indicated for reduction in signs and symptoms ofmoderately to severely active polyarticular-course juvenile rheumatoidarthritis in patients who have had an inadequate response to one or moreDMARDs (May 28, 1999). ENBREL is given to RA patients at 25 mg twiceweekly as a subcutaneous injection.

Currently, treatments using the sTNFR(p75):Fc (ENBREL, Immunex)preparations, including those described above, are administeredsubcutaneously twice weekly, which is costly, unpleasant andinconvenient for the patient. “Important Drug Warning” at<http://www.fda.gov/medwatch/safety/1999/enbrel.htm>; “New Warning ForArthritis Drug, ENBREL” at<http://www.fda.gov/bbs/topics/ANSWERS/ANS00954.html>; “ENBRELInjections Difficult for Some Patients” at<http://dailynews.yahoo.com/h/nm/20000516/hl/arthritis_drugs_(—)1.html>.Further, relief afforded by this treatment is not sustained. Symptomsassociated with an arthritic condition are reduced during treatment withsTNFR(p75):Fc but return upon discontinuation of this therapy, generallywithin one month. Complications have arisen, including local reactionsat the site of injection. Moreover, long-term systemic exposure to thisTNF-α antagonist can impose a risk for increased viral and bacterialinfections and possibly cancer. Since this product was first introduced,serious infections, some involving death, have been reported in patientsusing ENBREL. “Product Information” at<http://www.enbrel.com/patient/html/patpi.htm>; “Proven Tolerability” at<http://www.enbrel.com/patient/html/patsafety.htm>.

Additional relevant references include: U.S. Pat. Nos. 5,858,775;5,858,355; 5,858,351; 5,846,528; 5,843,742; 5,792,751; 5,786,211;5,780,447; 5,766,585; 5,633,145; International Patent publications WO95/16353; WO 94/20517; WO 92/11359; Schwarz, 1998, Keystone Symp., Jan.23-29, abstract 412; Song et al. (1998) J. Clin. Invest. 101:2615-2621;Ghivizzani et al., 1998, Proc. Natl. Acad. Sci. USA 95:4613-4618; Kanget al., 1997, Biochemical Society Transactions 25:533-537; Robbins etal., 1997, Drug News & Perspect. 10:283-292; Firestein et al., 1997, N.Eng. J. Med. 337:195-197; Muller-Ladner et al., 1997, J. Immunol.158:3492-3498; and Pelletier et al., 1997, Arthritis Rheum.40:1012-1019.

There is a need for new, effective forms of treatment for TNF-associateddisorders such as RA, particularly treatments that can providesustained, controlled therapy. The present invention providescompositions and methods for effective and continuous treatment ofinflammatory processes of arthritis and other TNF-associated disorders.

All publications and references cited herein are hereby incorporated byreference in their entirety.

SUMMARY OF THE INVENTION

The present invention is directed to compositions and methods forreducing TNF levels and/or treatment of TNF-associated disorders of amammal. The compositions generally comprise a recombinantadeno-associated virus (rAAV) vector that contains a polynucleotideencoding a TNF antagonist. The methods generally employ an rAAV vectorto deliver a polynucleotide encoding a TNF antagonist to the mammal,which in turn reduces the levels of TNF and results in palliation of anumber of TNF-associated disorders, such as arthritis (including RA),Crohn's disease, asthma and congestive heart failure. Lowering TNF mayin turn reduce levels of other disease causing or contributing agents,such as other inflammatory cytokines. Lowering the levels of soluble TNFin joints exhibiting RA can in turn palliate TNF-associated conditions,such as arthritis, and can reduce an inflammatory response in thejoints.

A preferred polynucleotide for the invention in the rAAV vectorsdescribed herein is one encoding a tumor necrosis factor receptor(TNFR). Since TNFR is capable of binding to soluble TNF, theintroduction of TNFR tends to reduce the levels of TNF in circulationand/or the affected tissues, such as the joint. In some embodiments, theinvention provides an rAAV vector comprising a polynucleotide encoding ap75 TNFR polypeptide. In other embodiments, the rAAV vectors of theinvention comprise a polynucleotide encoding an Fc (constant domain ofan immunoglobulin molecule):p75 fusion polypeptide. In otherembodiments, the rAAV vectors of the invention comprise a polynucleotideencoding a fusion polypeptide in which the extracellular domain of TNFRis fused to Fc.

In some embodiments, the rAAV vectors of the invention further comprisea polynucleotide encoding an IL-1 antagonist, such as an IL-1 receptortype II polypeptide.

In another aspect, the invention provides methods for reducing TNFlevels in a mammal, which comprise administering (i.e., delivering) anyof the rAAV vectors described herein to the mammal in an amountsufficient to reduce TNF levels. In some embodiments, the delivery of anrAAV vector is in an arthritic joint. In some embodiments, these methodsfurther comprise administering a TNF antagonist.

In another aspect, the invention provides methods for reducing aninflammatory response in a mammal, which comprise administering (i.e.,delivering) any of the rAAV vectors described herein to the mammal in anamount sufficient to reduce the inflammatory response. In someembodiments, these methods further comprise administering a TNFantagonist.

In another aspect, the invention provides methods for palliating aTNF-associated disoreder, such as an arthritic condition occurring in amammal, which comprise administering (i.e., delivering) any of the rAAVvectors described herein to the mammal in an amount sufficent topalliate the disorder (such as arthritic condition). In someembodiments, these methods further comprise administering a TNFantagonist.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts the amino acid sequence of a TNFR:Fc fusion polypeptide(SEQ ID NO: 1) from U.S. Pat. No. 5,605,690.

FIGS. 2A and 2B depicts the polynucleotide and amino acid sequences of aTNFR:Fc fusion polypeptide (SEQ ID NO: 2, 3) from U.S. Pat. No.5,605,690.

FIG. 3 depicts the amino acid and polynucleotide sequences of a humanIL-1R type II (SEQ ID NO: 4, 5) from GenBank U74649.

FIG. 4 depicts the nucleotide and amino acid sequences of rat TNFR (p80)extracellular domain (ECD) (SEQ ID NO: 6, 7).

FIGS. 5A and 5B depicts the amino acid sequence alignment of rat TNFR(p80) ECD (SEQ ID NO: 8), murine TNFR (p80) ECD (SEQ ID NO: 9) and humanTNFR (p75) ECD (SEQ ID NO: 10).

FIG. 6 depicts a diagram of the rat IgG1 heavy chain cDNA and therelative location of the PCR primers used to amplify the Fc portion ofthe IgG1 cDNA.

FIG. 7 depicts the nucleotide and amino acid sequences of rat IgG1Fc(SEQ ID NO: 11, 12).

FIGS. 8A, 8B and 8C depicts the nucleotide and amino acid sequences ofrat TNFR:Fc fusion construct (SEQ ID NO: 13, 14).

FIG. 9 depicts a diagram of the pCMVrTNFR-Fc expression plasmid,including the rat TNFR(p80)ECD-IgG1Fc fusion polynucleotide andoperatively linked control elements.

FIG. 10 depicts a northern analysis of RNA from cells tranfected withthe pCMVrTNFR-Fc expression plasmid.

FIG. 11 depicts a diagram of the rAAV vector plasmid pAAVCMVrTNFRFc,including the rat TNFR(p80)ECD-IgG1Fc fusion polynucleotide, operativelylinked control elements, including AAV ITRs.

FIG. 12 is a graph depicting the results of TNF inhibition bioassaysusing media collected from cells transfected with pCMVrTNFR-Fc (—♦—) andfrom cells transfected with pCMVGFP

FIG. 13 is a graph depicting results of TNF inhibition bioassays usingmedia from cells transduced with AAVCMVrTNFRFc particles (♦), from cellstransduced with AAV-lacZ particles (●), from mock infected cells (▴) andfrom cells transfected with pCMVrTNFR-Fc (▪).

FIG. 14 is a graph depicting results of TNF inhibition bioassays usingmedia from cells transduced with AAVCMVrTNFRFc particles at 100(♦), 500

1000

5000 (◯), or 10,000

particles per cell, as well as with media from mock infected cells (⊕)and from cells transfected with pCMVrTNFR-Fc (□).

FIG. 15 is a graph depicting a time course analysis of TNFR-Fcpolypeptide expression after transduction of cells with AAVCMVrTNFRFc at1000 particles per cell. The expression of TNFR-Fc was determined withTNF inhibition bioassays.

FIG. 16 is a photograph of joint tissue treated with rAAV-LacZ andhistochemically stained for β-galactosidase activity.

FIG. 17 is a photograph of arthritic joint tissue treated with rAAV-LacZand histochemically stained for β-galactosidase activity.

FIG. 18 is a photograph of arthritic joint tissue treated with PBS andhistochemically stained for β-galactosidase activity.

FIG. 19 is a graph depicting suppression of SCW-induced arthritis byrAAV-ratTNFR:Fc vector. Each point represents the mean +/− standarderror from the mean (SEM) for each group of rats.

FIG. 20 is a graph depicting suppression of arthritis symptoms in thecontralateral joint by AAV-ratTNFR:Fc vector. The AI scores for eachrear ankle paw was separately recorded and plotted. Each pointrepresents the mean +/− standard error from the mean (SEM) for eachgroup of rats.

FIG. 21 is a graph depicting serum expression of bioactive rat TNFR:Fcprotein in SCW-treated rats. Each point represents the mean +/− standarddeviation (SD) for each group of rats.

FIG. 22 is a graph depicting serum expression of bioactive rat TNFR:Fcprotein in naive rats. Each point represents the mean +/− standarddeviation (SD) for each group of rats.

DETAILED DESCRIPTION

We have discovered compositions and methods for reducing levels of TNFin a tissue, a particular anatomical site and/or the circulation of anindividual and methods for lowering TNF levels and for palliatingTNF-associated disorders. Included are methods for reducing inflammatoryresponse in a subject by reducing levels of TNF activity.

The invention described herein provides materials and methods for use inthe delivery to and expression of a polynucleotide encoding a TNFantagonist in a mammal. The polynucleotide encoding a TNF antagonist isdelivered to the mammal through a recombinant adeno-associated virus(rAAV) vector, a vector which integrates into the genome of the hostcell. Introduction of rAAV DNA into cells generally leads to long-termpersistence and expression of DNA without disturbing the normalmetabolism of the cell. Thus, the invention provides a continuous sourceof and ongoing administration of the TNF antagonist to the mammal. Thisis a distinct and significant advantage over previously describedtreatment modalities (i.e., exogenous administration of therapeuticagents), which confer only transient benefits.

Definitions

As used in the specification and claims, the singular form “a”, “an” and“the” include plural references unless the context clearly dictatesotherwise. For example, the term “a cell” includes a plurality of cells,including mixtures thereof.

A “TNF antagonist” as used herein refers to a polypeptide that binds TNFand inhibits and/or hinders TNF activity as reflected in TNF binding toa TNF-receptor including any of the following: (a) TNFR, preferablyendogenous (i.e., native to the individual or host), cell membrane boundTNFR; (b) the extracellular domain(s) of TNFR; and/or (c) the TNFbinding domains of TNFR (which may be a portion of the extracellulardomain). TNF antagonists include, but are not limited to, TNF receptors(or appropriate portions thereof, as described herein) and anti-TNFantibodies. As used herein, the “biological activity” of a TNFantagonist is to bind to TNF and inhibit and/or hinder TNF from bindingto any of the following: (a) TNFR, preferably endogenous, cell membranebound TNFR; (b) the extracellular domain(s) of TNFR; and (c) the TNFbinding domains of TNFR (which may be a portion of the extracellulardomain). A TNF antagonist can be shown to exhibit biological activityusing assays known in the art to measure TNF activity and itsinhibition, an example of which is provided herein.

“TNF-associated disorders” are those disorders or diseases that areassociated with, result from, and/or occur in response to, elevatedlevels of TNF. Such disorders may be associated with episodic or chronicelevated levels of TNF activity and/or with local or systemic increasesin TNF activity. Such disorders include, but are not limited to,inflammatory diseases, such as arthritis and inflammatory bowel disease,and congestive heart failure.

As used herein, the terms “TNF receptor polypeptide” and “TNFRpolypeptide” refer to polypeptides derived from TNFR (from any species)which are capable of binding TNF. Two distinct cell-surface TNFRs havedescribed: Type II TNFR (or p75 TNFR or TNFRII) and Type I TNFR (or p55TNFR or TNFRI). The mature full-length human p75 TNFR is a glycoproteinhaving a molecular weight of about 75-80 kilodaltons (kD). The maturefull-length human p55 TNFR is a glycoprotein having a molecular weightof about 55-60 kD. The preferred TNFR polypeptides of this invention arederived from TNFR Type I and/or TNFR type II.

TNFR polypeptides, such as “TNFR”, “TNFR:Fc” and the like, whendiscussed in the context of the present invention and compositionstherefor, refer to the respective intact polypeptide (such as, TNFRintact), or any fragment or derivative thereof (such as, an amino acidsequence derivative), that exhibits the desired biological activity(i.e., binding to TNF). A “TNFR polynucleotide” is any polynucleotidewhich encodes a TNFR polypeptide (such as a TNFR:Fc polypeptide).

As used herein, an “extracellular domain” of TNFR refers to a portion ofTNFR that is found between the amino-terminus of TNFR and theamino-terminal end of the TNFR transmembrane region. The extracellulardomain of TNFR binds TNF.

A “IL-1 antagonist” as used herein refers to a polypeptide that bindsinterleukin 1 (IL-1) and inhibits and/or hinders IL-1 activity asreflected in IL-1 binding to an IL-1 receptor including any of thefollowing: (a) IL-1 receptor (IL-1R), preferably endogenous (i.e.,native to the individual or host), cell membrane bound IL-1R; (b) theextracellular domain(s) of IL-1R; and/or (c) the IL-1 binding domains ofIL-1R (which may be a portion of the extracellular domain). IL-1antagonists include, but are not limited to, IL-1 receptors (orappropriate portions thereof, as described herein) and anti-IL-1antibodies. As used herein, the “biological activity” of an IL-1antagonist is to bind to IL-1 and inhibit and/or hinder IL-1 frombinding to any of the following: (a) IL-1R, preferably endogenous, cellmembrane bound IL-1R; (b) the extracellular domain(s) of IL-1R; and/or(c) the IL-1 binding domains of IL-1R (which may be a portion of theextracellular domain). An IL-1 antagonist can be shown to exhibitbiological activity using assays known in the art, including IL-1inhibition assays, which are described herein as well as in the art.

As used herein, the term “IL-1 receptor polypeptide” refers topolypeptides derived from IL-1 receptor (from any species) which arecapable of binding IL-1. IL-1R polypeptides, when discussed in thecontext of the present invention and compositions therefor, refer to therespective intact polypeptide (such as intact IL-1R), or any fragment orderivative thereof (such as, an amino acid sequence derivative), thatexhibits the desired biological activity (i.e., binding to IL-1). A“IL-1R polynucleotide” is any polynucleotide which encodes a IL-1Rpolypeptide.

As used herein, an “extracellular domain” of IL-1R refers to a portionof IL-1R that is found between the amino-terminus of IL-1R and theamino-terminal end of the IL-1R transmembrane region. The extracellulardomain of IL-1R binds IL-1.

The terms “polypeptide”, “peptide” and “protein” are usedinterchangeably herein to refer to polymers of amino acids of anylength. The terms also encompass an amino acid polymer that has beenmodified; for example, disulfide bond formation, glycosylation,lipidation, or conjugation with a labeling component.

A “chimeric polypeptide” or “fusion polypeptide” is a polypeptidecomprising regions in a different position than occurs in nature. Theregions may normally exist in separate proteins and are brought togetherin the chimeric or fusion polypeptide, or they may normally exist in thesame protein but are placed in a new arrangement in the chimeric orfusion polypeptide. A chimeric or fusion polypeptide may also arise frompolymeric forms, whether linear or branched, of TNFR polypeptide(s).

The terms “polynucleotide” and “nucleic acid”, used interchangeablyherein, refer to a polymeric form of nucleotides of any length,including deoxyribonucleotides or ribonucleotides, or analogs thereof. Apolynucleotide may comprise modified nucleotides, such as methylatednucleotides and nucleotide analogs, and may be interrupted bynon-nucleotide components. If present, modifications to the nucleotidestructure may be imparted before or after assembly of the polymer. Theterm polynucleotide, as used herein, refers interchangeably to double-and single-stranded molecules. Unless otherwise specified or required,any embodiment of the invention described herein that is apolynucleotide encompasses both the double-stranded form and each of twocomplementary single-stranded forms known or predicted to make up thedouble-stranded form.

A “chimeric polynucleotide” or “fusion polynucleotide” is apolynucleotide comprising regions in a different position than occurs innature. The regions may normally exist in separate genes and are broughttogether in the chimeric or fusion polynucleotide, or they may normallyexist in the same gene but are placed in a new arrangement in thechimeric or fusion polynucleotide.

“AAV” is an abbreviation for adeno-associated virus, and may be used torefer to the virus itself or derivatives thereof. The term covers allsubtypes and both naturally occurring and recombinant forms, exceptwhere required otherwise.

An “rAAV vector” as used herein refers to an AAV vector comprising apolynucleotide sequence not of AAV origin (i.e., a polynucleotideheterologous to AAV), typically a sequence of interest for the genetictransformation of a cell. The heterologous polynucleotide is flanked byat least one, preferably two, AAV inverted terminal repeat sequences(ITRs). As described herein, an rAAV vector can be in any of a number offorms, including, but not limited to, plasmids, linear artificialchromosomes, complexed with lipids, encapsulated within liposomes and,most preferably, encapsidated in a viral particle, particularly an AAV.

An “rAAV virus” or “rAAV viral particle” refers to a viral particlecomposed of at least one AAV capsid protein (preferably by all of thecapsid proteins of a wild-type AAV) and an encapsidated rAAV.

“Packaging” refers to a series of intracellular events that result inthe assembly and encapsidation of an AAV particle or rAAV particle.

AAV “rep” and “cap” genes refer to polynucleotide sequences encodingreplication and encapsidation proteins of adeno-associated virus. Theyhave been found in all AAV serotypes examined, and are described belowand in the art. AAV rep and cap are referred to herein as AAV “packaginggenes”.

A “helper virus” for AAV refers to a virus that allows AAV to bereplicated and packaged by a mammalian cell. A variety of such helperviruses for AAV are known in the art, including adenoviruses,herpesviruses and poxviruses such as vaccinia. The adenovirusesencompass a number of different subgroups, although Adenovirus type 5 ofsubgroup C is most commonly used. Numerous adenoviruses of human,non-human mammalian and avian origin are known and available fromdepositories such as the ATCC. Viruses of the herpes family include, forexample, herpes simplex viruses (HSV) and Epstein-Barr viruses (EBV), aswell as cytomegaloviruses (CMV) and pseudorabies viruses (PRV); whichare also available from depositories such as ATCC.

An “infectious” virus or viral particle is one that comprises apolynucleotide component which it is capable of delivering into a cellfor which the viral species is trophic. The term does not necessarilyimply any replication capacity of the virus. Assays for countinginfectious viral particles are described in the art.

A “replication-competent” virus (e.g., a replication-competent AAV,sometimes abbreviated as “RCA”) refers to a phenotypically wild-typevirus that is infectious, and is also capable of being replicated in aninfected cell (i.e., in the presence of a helper virus or helper virusfunctions). In the case of AAV, replication competence generallyrequires the presence of functional AAV packaging genes. Preferred rAAVvectors as described herein are replication-incompetent in mammaliancells (especially in human cells) by virtue of the lack of one or moreAAV packaging genes. Preferably, such rAAV vectors lack any AAVpackaging gene sequences in order to minimize the possibility that RCAare generated by recombination between AAV packaging genes and an rAAVvector.

A “gene” refers to a polynucleotide containing at least one open readingframe that is capable of encoding a particular protein after beingtranscribed and translated.

“Recombinant”, as applied to a polynucleotide means that thepolynucleotide is the product of various combinations of cloning,restriction or ligation steps, and other procedures that result in aconstruct that is distinct from a polynucleotide found in nature. Arecombinant virus is a viral particle comprising a recombinantpolynucleotide. The terms respectively include replicates of theoriginal polynucleotide construct and progeny of the original virusconstruct.

A “control element” or “control sequence” is a nucleotide sequenceinvolved in an interaction of molecules that contributes to thefunctional regulation of a polynucleotide, including replication,duplication, transcription, splicing, translation, or degradation of thepolynucleotide. The regulation may affect the frequency, speed, orspecificity of the process, and may be enhancing or inhibitory innature. Control elements known in the art include, for example,transcriptional regulatory sequences such as promoters and enhancers. Apromoter is a DNA region capable under certain conditions of binding RNApolymerase and initiating transcription of a coding region usuallylocated downstream (in the 3′ direction) from the promoter.

“Operatively linked” or “operably linked” refers to a juxtaposition ofgenetic elements, wherein the elements are in a relationship permittingthem to operate in the expected manner. For instance, a promoter isoperatively linked to a coding region if the promoter helps initiatetranscription of the coding sequence. There may be intervening residuesbetween the promoter and coding region so long as this functionalrelationship is maintained.

“Heterologous” means derived from a genotypically distinct entity fromthat of the rest of the entity to which it is being compared. Forexample, a polynucleotide introduced by genetic engineering techniquesinto a plasmid or vector derived from a different species is aheterologous polynucleotide. A promoter removed from its native codingsequence and operatively linked to a coding sequence with which it isnot naturally found linked is a heterologous promoter.

“Genetic alteration” refers to a process wherein a genetic element isintroduced into a cell other than by mitosis or meiosis. The element maybe heterologous to the cell, or it may be an additional copy or improvedversion of an element already present in the cell. Genetic alterationmay be effected, for example, by transfecting a cell with a recombinantplasmid or other polynucleotide through any process known in the art,such as electroporation, calcium phosphate precipitation, or contactingwith a polynucleotide-liposome complex. Genetic alteration may also beeffected, for example, by transduction or infection with a DNA or RNAvirus or viral vector. Preferably, the genetic element is introducedinto a chromosome or mini-chromosome in the cell; but any alterationthat changes the phenotype and/or genotype of the cell and its progenyis included in this term.

A cell is said to be “stably” altered, transduced, or transformed with agenetic sequence if the sequence is available to perform its functionduring extended culture of the cell in vitro. In preferred examples,such a cell is “inheritably” altered in that a genetic alteration isintroduced which is also inheritable by progeny of the altered cell.

“Stable integration” of a polynucleotide into a cell means that thepolynucleotide has been integrated into a replicon that tends to bestably maintained in the cell. Although episomes such as plasmids cansometimes be maintained for many generations, genetic material carriedepisomally is generally more susceptible to loss thanchromosomally-integrated material. However, maintenance of apolynucleotide can often be effected by incorporating a selectablemarker into or adjacent to a polynucleotide, and then maintaining cellscarrying the polynucleotide under selective pressure. In some cases,sequences cannot be effectively maintained stably unless they havebecome integrated into a chromosome; and, therefore, selection forretention of a sequence comprising a selectable marker can result in theselection of cells in which the marker has become stably-integrated intoa chromosome. Antibiotic resistance genes can be conveniently employedas such selectable markers, as is well known in the art. Typically,stably-integrated polynucleotides would be expected to be maintained onaverage for at least about twenty generations, preferably at least aboutone hundred generations, still more preferably they would be maintainedpermanently. The chromatin structure of eukaryotic chromosomes can alsoinfluence the level of expression of an integrated polynucleotide.Having the genes carried on stably-maintained episomes can beparticularly useful where it is desired to have multiplestably-maintained copies of a particular gene. The selection of stablecell lines having properties that are particularly desirable in thecontext of the present invention are described and illustrated below.

An “isolated” plasmid, virus, or other substance refers to a preparationof the substance devoid of at least some of the other components thatmay also be present where the substance or a similar substance naturallyoccurs or is initially prepared from. Thus, for example, an isolatedsubstance may be prepared by using a purification technique to enrich itfrom a source mixture. Enrichment can be measured on an absolute basis,such as weight per volume of solution, or it can be measured in relationto a second, potentially interfering substance present in the sourcemixture. Increasing enrichments of the embodiments of this invention areincreasingly more preferred. Thus, for example, a 2-fold enrichment ispreferred, 10-fold enrichment is more preferred, 100-fold enrichment ismore preferred, 1000-fold enrichment is even more preferred.

A preparation of rAAV is said to be “substantially free” of helper virusif the ratio of infectious rAAV particles to infectious helper virusparticles is at least about 10²:1; preferably at least about 10⁴:1, morepreferably at least about 10⁶:1; still more preferably at least about10⁸:1. Preparations are also preferably free of equivalent amounts ofhelper virus proteins (i.e., proteins as would be present as a result ofsuch a level of helper virus if the helper virus particle impuritiesnoted above were present in disrupted form). Viral and/or cellularprotein contamination can generally be observed as the presence ofCoomassie staining bands on SDS gels (e.g. the appearance of bands otherthan those corresponding to the AAV capsid proteins VP1, VP2 and VP3).

A “host cell” includes an individual cell or cell culture which can beor has been a recipient for vector(s) or for incorporation ofpolynucleotides and/or proteins. Host cells include progeny of a singlehost cell, and the progeny may not necessarily be completely identical(in morphology or in genomic of total DNA complement) to the originalparent cell due to natural, accidental, or deliberate mutation. A hostcell includes cells transfected in vivo with a polynucleotide(s) of thisinvention.

“Transformation” or “transfection” refers to the insertion of anexogenous polynucleotide into a host cell, irrespective of the methodused for the insertion, for example, lipofection, transduction,infection or electroporation. The exogenous polynucleotide may bemaintained as a non-integrated vector, for example, a plasmid, oralternatively, may be integrated into the host cell genome.

An “individual” or “subject” refers to vertebrates, particularly membersof a mammalian species, and includes, but is not limited to, domesticanimals, sports animals, rodents and primates, including humans.

An “effective amount” is an amount sufficient to effect beneficial ordesired clinical results. An effective amount can be administered in oneor more administrations. For purposes of this invention, an “effectiveamount” is an amount that achieves any of the following: reduction ofTNF levels; reduction of an inflammatory response; and/or palliation,amelioration, stabilization, reversal, slowing or delay in theprogression of the disease state.

As used herein, “in conjunction with” refers to administration of onetreatment modality in addition to another treatment modality, such asadminstration of a TNF antagonist to a subject in addition to thedelivery of an rAAV to the same subject, or administration of twodifferent rAAV vectors to the same subject. As such, “in conjunctionwith” refers to administration of one treatment modality before, duringor after delivery of the other treatment modality to the subject.

An “arthritic condition” is a term well-understood in the art refers toa state characterized by inflammation of a joint or joints.

As used herein, “treatment” is an approach for obtaining beneficial ordesired clinical results. For purposes of this invention, beneficial ordesired clinical results include, but are not limited to, alleviation ofsymptoms, diminishment of extent of disease, stabilized (i.e., notworsening) state of disease, preventing spread of disease, delay orslowing of disease progression, amelioration or palliation of thedisease state, and remission (whether partial or total), whetherdetectable or undetectable. “Treatment” can also mean prolongingsurvival as compared to expected survival if not receiving treatment.For example, treatment of an individual may be undertaken to decrease orlimit the pathology associated with elevated levels of TNF, including,but not limited to, an inherited or induced genetic deficiency,infection by a viral, bacterial, or parasitic organism, a neoplastic oraplastic condition, or an immune system dysfunction such asautoimmunity. Treatment may be performed either prophylactically ortherapeutically; that is, either prior or subsequent to the initiationof a pathologic event or contact with an etiologic agent.

A “biological sample” encompasses a variety of sample types obtainedfrom an individual and can be used in a diagnostic or monitoring assay.The definition encompasses blood and other liquid samples of biologicalorigin, solid tissue samples such as a biopsy specimen or tissuecultures or cells derived therefrom, and the progeny thereof. Thedefinition also includes samples that have been manipulated in any wayafter their procurement, such as by treatment with reagents,solubilization, or enrichment for certain components, such as proteinsor polynucleotides. The term “biological sample” encompasses a clinicalsample, and also includes cells in culture, cell supernatants, celllysates, serum, plasma, biological fluid, and tissue samples.

“Palliating” a disease means that the extent and/or undesirable clinicalmanifestations of a disease state are lessened and/or time course of theprogression is slowed or lengthened, as compared to not administeringrAAV vectors of the present invention.

General Techniques

The practice of the present invention will employ, unless otherwiseindicated, conventional techniques of molecular biology, virology,animal cell culture and biochemistry which are within the skill of theart. Such techniques are explained fully in the literature. See, forexample, “Molecular Cloning: A Laboratory Manual”, Second Edition(Sambrook, Fritsch & Maniatis, 1989); “Animal Cell Culture” (R. I.Freshney, ed., 1987); “Gene Transfer Vectors for Mammalian Cells” (J. M.Miller & M. P. Calos, eds., 1987); “Current Protocols in MolecularBiology” (F. M. Ausubel et al., eds., 1987); “Current Protocols inProtein Science” (John E Coligan, et al. eds. Wiley and Sons, 1995); and“Protein Purification: Principles and Practice” (Robert K. Scopes,Springer-Verlag, 1994).

rAAV Vectors for Delivery of TNF Antagonist

This invention provides recombinant AAV (rAAV) vectors for reducinglevels of TNF in a subject. This reduction may occur anywhere in thebody, such as in a tissue(s), a particular anatomical site and/orcirculation. Generally, these rAAV vectors comprise a polynucleotideencoding a TNF antagonist. Preferably the TNF antagonist is a TNFR, or aTNFR polypeptide (including biologically active derivative(s) thereof).In the present invention, a preferred TNFR is derived from the p75 TNFR.

An rAAV vector of this invention comprises a heterologous (i.e. non-AAV)polynucleotide of interest in place of the AAV rep and/or cap genes thatnormally make up the bulk of the AAV genome. As in the wild-type AAVgenome, however, the heterologous polynucleotide is preferably flankedby at least one, more preferably two, AAV inverted terminal repeats(ITRs). Variations in which an rAAV construct is flanked by a only asingle (typically modified) ITR have been described in the art and canbe employed in connection with the present invention.

TNF Antagonists

In the present invention, a TNF antagonist is supplied to an individual,preferably a mammal, most preferably a human, as an expressed product ofa polynucleotide which encodes a TNF antagonist. The polynucleotideencoding the TNF antagonist is delivered to the mammal in the form of anrAAV vector. As defined, such a TNF antagonist may be any polypeptidewhich binds to TNF including, but not limited to, a TNFR polypeptide andan anti-TNF antibody.

The TNF antagonist is secreted by the cell that receives the rAAVvector; preferably the TNF antagonist is soluble (i.e., not attached tothe cell). For example, soluble TNF antagonists are devoid of atransmembrane region and are secreted from the cell. Techniques toidentify and remove polynucleotide sequences which encode transmembranedomains are known in the art.

Preferably, the TNF antagonist is a TNFR polypeptide. TNFR polypeptidemay be an intact TNFR (preferably from the same species that receivesthe rAAV) or a suitable fragment of TNFR. U.S. Patent 5,605,690 providesexamples of TNFR polypeptides, including soluble TNFR polypeptides,appropriate for use in the present invention. Preferably, the TNFRpolypeptide comprises an extracelluar domain of TNFR. More preferably,the TNFR polypeptide is a fusion polypeptide comprising an extracellulardomain of TNFR linked to a constant domain of an immunoglobulinmolecule; still more preferably, the TNFR polypeptide is a fusionpolypeptide comprising an extracellular domain of the p75 TNFR linked toa constant domain of an IgG1 molecule. Preferably when administration tohumans is contemplated, an Ig used for fusion proteins is human,preferably human IgG1.

Monovalent and multivalent forms of TNFR polypeptides may be used in thepresent invention. Multivalent forms of TNFR polypeptides possess morethan one TNF binding site. Multivalent forms of TNFR polypeptides may beencoded in an rAAV vector, for example, through the repeated ligation ofpolynucleotides encoding TNF binding domains, each repeat beingseparated by a linker region. Preferably, the TNFR of the presentinvention is a bivalent, or dimeric, form of TNFR. For example, asdescribed in U.S. Pat. No. 5,605,690 and in Mohler et al., 1993, J.Immunol., 151:1548-1561, a chimeric antibody polypeptide with TNFRextracellular domains substituted for the variable domains of either orboth of the immunoglobulin heavy or light chains would provide a TNFRpolypeptide for the present invention. Generally, when such a chimericTNFR:antibody polypeptide is produced by cells, it forms a bivalentmolecule through disulfide linkages between the immunoglobulin domains.Such a chimeric TNFR:antibody polypeptide is referred to as TNFR:Fc.

The TNFR polypeptide construct sTNFR(p75):Fc is a preferred embodimentof a TNF antagonist of the present invention. The polypeptide sequenceof sTNFR(p75):Fc is depicted in FIG. 1. The coding sequence for this TNFantagonist is found in plasmid pCAVDHFRhuTNFRFc as described in U.S.Pat. No. 5,605,690. Any polynucleotide which encodes this sTNFR(p75):Fcpolypeptide is suitable for use in the present invention. Apolynucleotide sequence encoding sTNFR(p75):Fc is depicted in FIG. 2.

In the present invention, additional TNFR polypeptide sequences include,but are not limited to, those indicated in FIGS. 2 and 3 of U.S. Pat.No. 5,395,760.

Polynucleotides which encode TNFR polypeptides can be generated usingmethods known in the art from TNFR polynucleotide sequences known in theart. In the present invention, preferable polynucleotide sequences whichencode TNFR polypeptides include, but are not limited to, TNFRpolynucleotide sequences found in U.S. Pat. Nos. 5,395,760 and 5,605,690and GenBank entries M32315 (human TNFR) and M59378 (murine TNFRI).Suitable polynucleotides for use in the present invention can besynthesized using standard synthesis and recombinant methods.

Methods to assess TNF antagonist activity are known in the art andexemplified herein. For example, TNF antagonist activity may be assessedwith a cell-based competitive binding assay. In such an assay,radiolabelled TNF is mixed with serially diluted TNF antagonist andcells expressing cell membrane bound TNFR. Portions of the suspensionare centrifuged to separate free and bound TNF and the amount ofradioactivity in the free and bound fractions determined. TNF antagonistactivity is assessed by inhibition of TNF binding to the cells in thepresence of the TNF antagonist.

As another example, TNF antagonists may be analyzed for the ability toneutralize TNF activity in vitro in a bioassay using cells susceptibleto the cytotoxic activity of TNF as target cells, such as L929 cells(see, for example, Example 3). In such an assay, target cells, culturedwith TNF, are treated with varying amounts of TNF antagonist andsubsequently are examined for cytolysis. TNF antagonist activity isassessed by a decrease in TNF-induced target cell cytolysis in thepresence of the TNF antagonist.

The invention also provides rAAV vectors comprising a polynucleotideencoding an interleukin 1 (IL-1) antagonist. The cytokine IL-1 has beenimplicated as a pivotal mediator in both the early and late diseasestages of RA (Joosten et al., 1996, Arthritis Rheum. 39:797-809). In RA,IL-1 appears to be involved in infiltration of inflammatory cells andcartilage destruction in the affected joint. A clinical trial with anIL-1 antagonist in patients with RA indicated that blocking IL-1activity may result in amelioration of RA symptoms (Campion et al.,1996, Arthritis Rheum. 39:1092-1101; Bresnihan et al., 1996, ArthritisRheum. 39:S73). In a murine arthritis model, a combinedanti-TNFα/anti-IL-1 treatment led to both diminished inflammation and todiminished joint cartilage damage (Kuiper et al., 1998, Cytokine10:690-702).

As IL-1 and TNF appear to mediate different aspects of RA, the presentinvention provides rAAV vectors comprising a polynucleotide encoding aTNF antagonist (such as sTNFR(p75):Fc) and an IL-1 antagonist (or, therAAV vector comprises a polynucleotide which encodes a TNF antagonistand an IL-1 antagonist). The present invention also provides rAAVvectors comprising a polynucleotide encoding an IL-1 antagonist.Preferably, the IL-1 antagonist is an IL-1 receptor (IL-1R), or an IL-1Rpolypeptide (including biologically active derivatives(s) thereof), thatexhibits the desired biological activity (i.e., binding to IL-1).Preferably, the IL-1R is derived from IL-1R type II. In the presentinvention, preferable IL-1R polypeptide sequences include, but are notlimited to, that depicted in FIG. 3 and those found in IL-1R GenBankentry U74649 and U.S. Pat. No. 5,350,683. Any polynucleotide whichencodes an IL-1R polypeptide is suitable for use in the presentinvention. A polynucleotide sequence encoding a preferred IL-1Rpolypeptide is depicted in FIG. 3. Suitable polynucleotides for use inthe present invention can be synthesized using standard synthesis andrecombinant methods.

Methods to assess IL-1 antagonist activity are known in the art. Forexample, IL-1 antagonist activity may be assessed with a cell-basedcompetitive binding assay as described herein for TNF antagonists. Asanother example, IL-1 antagonist activity may be assessed for theability to neutralize IL-1 activity in vitro in a bioassay for IL-1. Insuch an assay, a cell line (for example, EL-4 NOB-1) is used thatproduces interleukin 2 (IL-2) in response to treatment with IL-1. ThisIL-1 responsive cell line is used in combination with a IL-2 sensitivecell line (for example, CTLL-2). Proliferation of the IL-2 sensitivecell line is dependent on the IL-1 responsive cell line producing IL-2and thus, is used as a measure of Il-1 stimulation of the IL-1responsive cell line. IL-1 antagonist activity would be assessed by itsability to neutralize IL-1 activity in such a IL-1 bioassay (Gearing etal., 1991, J. Immunol. Methods 99:7-11; Kuiper et al., 1998).

In preferred embodiments, the vector(s) of the invention areencapsidated into an rAAV virus particle. Accordingly, the inventionincludes an rAAV virus particle (recombinant because it contains arecombinant polynucleotide) comprising any of the vectors describedherein. Methods of producing such particles are described below.

The present invention also provides compositions containing any of therAAV vectors (and/or rAAV virus particles comprising the rAAV vectors)described herein. These compositions are especially useful foradministration to individuals who may benefit from a reduction in thelevel of TNF.

Generally, the compositions of the invention for use in reducing TNFlevels comprise an effective amount of an rAAV vector encoding a TNFantagonist, preferably in a pharmaceutically acceptable excipient. As iswell known in the art, pharmaceutically acceptable excipients arerelatively inert substances that facilitate administration of apharmacologically effective substance and can be supplied as liquidsolutions or suspensions, as emulsions, or as solid forms suitable fordissolution or suspension in liquid prior to use. For example, anexcipient can give form or consistency, or act as a diluent. Suitableexcipients include but are not limited to stabilizing agents, wettingand emulsifying agents, salts for varying osmolarity, encapsulatingagents, and buffers. Excipients as well as formulations for parenteraland nonparenteral drug delivery are set forth in Remington'sPharmaceutical Sciences 19th Ed. Mack Publishing (1995).

Generally, these rAAV compositions are formulated for administration byinjection (e.g., intra-articularly, intravenously, intramuscularly,etc.). Accordingly, these compositions are preferably combined withpharmaceutically acceptable vehicles such as saline, Ringer's balancedsalt solution (pH 7.4), dextrose solution, and the like. Although notrequired, pharmaceutical compositions may optionally be supplied in unitdosage form suitable for administration of a precise amount.

The invention also includes any of the above vectors (or compositionscomprising the vectors) for use in treatment of TNF-associateddisorders, such as inflammatory conditions (including arthritis). Theinvention also includes any of the above vectors (or compositionscomprising the vectors) for use in reducing TNF levels in an individual.The invention further provides use of any of the above vectors (orcompositions comprising the vectors) in the manufacture of a medicamentfor treatment of TNF-associated disorders, such as inflammatoryconditions (including arthritis). The invention also provides use of anyof the above vectors (or compositions comprising the vectors) in themanufacture of a medicament for reducing TNF activity levels in anindividual.

Host Cells Comprising an rAAV of the Invention

The present invention also provides host cells comprising rAAV vectorsdescribed herein. Among eukaryotic host cells are yeast, insect, avian,plant and mammalian cells. Preferably, the host cells are mammalian. Forexample, host cells include, but are not limited to, HeLa and 293 cells,both of human origin and both readily avaliable.

The development of host cells able to express the rAAV vector sequenceprovides an established source of the material that is expressed at areliable level. Methods and compositions for introducing the rAAV vectorinto the host cell and then for determining whether a host cell containsthe rAAV vector are discussed in a later section, have been describedart and are widely available.

Included in these embodiments, and discussed in a later section are socalled “producer cells” used as a basis for producing packaged rAAVvectors.

Preparation of the rAAV of the Invention

The rAAV vectors of this invention may be prepared using standardmethods in the art. Adeno-associated viruses of any serotype aresuitable, since the various serotypes are functionally and structurallyrelated, even at the genetic level (see, e.g., Blacklow, pp. 165-174 of“Parvoviruses and Human Disease” J. R. Pattison, ed. (1988); and Rose,Comprehensive Virology 3:1, 1974). All AAV serotypes apparently exhibitsimilar replication properties mediated by homologous rep genes; and allgenerally bear three related capsid proteins such as those expressed inAAV2. The degree of relatedness is further suggested by heteroduplexanalysis which reveals extensive cross-hybridization between serotypesalong the length of the genome; and the presence of analogousself-annealing segments at the termini that correspond to ITRs. Thesimilar infectivity patterns also suggest that the replication functionsin each serotype are under similar regulatory control. Among the variousAAV serotypes, AAV2 is most commonly employed. For a general review ofAAV biology and genetics, see, e.g., Carter, “Handbook of Parvoviruses”,Vol. I, pp. 169-228 (1989), and Berns, “Virology”, pp. 1743-1764, RavenPress, (1990). General principles of rAAV vector construction are knownin the art. See, e.g., Carter, 1992, Current Opinion in Biotechnology,3:533-539; and Muzyczka, 1992, Curr. Top. Microbiol. Immunol.,158:97-129.

As described above, the rAAV vectors of this invention comprise aheterologous polynucleotide that encodes a TNF antagonist. The rAAVvectors may also encode additional polypeptides, such as an IL-1receptor type II. Alternatively, the rAAV vectors may comprise aheterologous polynucleotide that encodes an IL-1 antagonist, such as anIL-1R. Such a heterologous polynucleotide will generally be ofsufficient length to provide the encoding sequence and desired function.For encapisdation within AAV2 particles, the heterologous polynucleotidewill preferably be less than about 5 kb although other serotypes and/ormodifications may be employed to allow larger sequences to packaged intothe AAV viral particles. For example, a preferred polynucleotide encodesa TNFR:Fc as represented in SEQ ID NO: 1, is about 1.5 kb in length.

Since transcription of the heterologous polynucleotide is desired in theintended target cell, it can be operably linked to its own or to aheterologous promoter and/or enhancer, depending for example on thedesired level and/or specificity of transcription within the targetcell, as is known in the art. Various types of promoters and enhancersare suitable for use in this context. For example, Feldhaus (U.S. patentapplication Ser. No. 09/171,759, filed Oct. 20, 1998) describes amodified ITR comprising a promoter to regulate expression from an rAAV.Constitutive promoters provide an ongoing level of gene transcription,and are preferred when it is desired that the therapeutic polynucleotidebe expressed on an ongoing basis. Inducible or regulatable promotersgenerally exhibit low activity in the absence of the inducer, and areup-regulated in the presence of the inducer. They may be preferred whenexpression is desired only at certain times or at certain locations, orwhen it is desirable to titrate the level of expression using aninducing agent. Promoters and enhancers may also be tissue-specific,that is, they exhibit their activity only in certain cell types,presumably due to gene regulatory elements found uniquely in thosecells. Such tissue-specific promoters and enhancers are known in theart. By way of illustration, an example of tissue-specific promotersincludes various myosin promoters for expression in muscle. Anotherexample of tissue-specific promoters and enhancers are of regulatoryelements for cell and/or tissue types that are in a joint.

Preferred inducible or regulated promoters and/or enhancers includethose that are physiologically responsive, such as those that areresponsive to inflammatory signals and/or conditions. For example, useof promoters and/or enhancers that are activated in response tomediators that drive inflammatory flares, including, but not limited to,those from proinflammatory cytokine genes (e.g., TNFα, IL-1β and IFNγ),would result in the expression of a TNF antagonist during the period ofinflammatory flare (Varley et al., 1998, Mol. Med. Today 4:445-451). TheTNFα promoter region is approximately 1.2 kb, and the sequence has beenreported by Takashiba et al., 1993, Gene, 131:307-308.

Further illustrative examples of promoters are the SV40 late promoterfrom simian virus 40, the Baculovirus polyhedron enhancer/promoterelement, Herpes Simplex Virus thymidine kinase (HSV tk), the immediateearly promoter from cytomegalovirus (CMV) and various retroviralpromoters including LTR elements. Additional inducible promoters includeheavy metal ion inducible promoters (such as the mouse mammary tumorvirus (mMTV) promoter or various growth hormone promoters), and thepromoters from T7 phage which are active in the presence of T7 RNApolymerase. A large variety of other promoters are known and generallyavailable in the art, and the sequences for many such promoters areavailable in sequence databases such as the GenBank database.

As translation is also desired in the intended target cell, theheterologous polynucleotide encoding a TNF antagonist will preferablyalso comprise control elements that facilitate translation (such as aribosome binding site or “RBS” and a polyadenylation signal).Accordingly, the heterologous polynucleotide will generally comprise atleast one coding region operatively linked to a suitable promoter, andcan also comprise, for example, an operatively linked enhancer, ribosomebinding site and poly-A signal. The heterologous polynucleotide cancomprise one encoding region, or more than one encoding region under thecontrol of the same or different promoters. The entire unit, containinga combination of control elements and encoding region, is often referredto as an expression cassette.

A heterologous polynucleotide encoding a TNF antagonist is integrated byrecombinant techniques into or preferably in place of the AAV genomiccoding region (i.e., in place of the AAV rep and cap genes), but isgenerally flanked on either side by AAV ITRs. This means that an ITRappears both upstream and downstream from the coding sequence, either indirect juxtaposition, preferably (although not necessarily) without anyintervening sequence of AAV origin in order to reduce the likelihood ofrecombination that might regenerate a replication-competent AAV (“RCA”)genome. Recent evidence suggests that a single ITR can be sufficient tocarry out the functions normally associated with configurationscomprising two ITRs (U.S. Pat. No. 5,478,745), and vector constructswith only one ITR can thus be employed in conjunction with the packagingand production methods described herein. The resultant rAAV vector isreferred to as being “defective” in AAV functions when specific AAVcoding sequences are deleted from the vector.

Given the relative encapsidation size limits of various AAV genomes,insertion of a large heterologous polynucleotide into the genomenecessitates removal of a portion of the AAV genome, in particular, oneor more of the packaging genes may be removed. Removal of one or moreAAV genes is in any case desirable, to reduce the likelihood ofgenerating RCA. Accordingly, encoding or promoter sequences for rep,cap, or both, are preferably removed, since the functions provided bythese genes can be provided in trans.

The rAAV vectors are provided in a variety of forms, such as in the formof bacterial plasmids, AAV particles, liposomes or any combinationthereof. In other embodiments, the rAAV vector sequence is provided inthe eukaryotic cells transfected with the rAAV vector.

If the rAAV is to be used in the form of a packaged rAAV particle, thereare at least three desirable features of an rAAV virus preparation foruse in gene transfer. First, it is preferred that the rAAV virus shouldbe generated at titers sufficiently high to transduce an effectiveproportion of cells in the target tissue. High number of rAAV viralparticles are typically required for gene transfer in vivo. For example,some treatments may require in excess of 10⁸ particles. Second, it ispreferred that the rAAV virus preparations should be essentially free ofreplication-competent AAV (i.e., phenotypically wild-type AAV which canbe replicated in the presence of helper virus or helper virusfunctions). Third, it is preferred that the rAAV virus preparation as awhole be essentially free of other viruses (such as a helper virus usedin AAV production) as well as helper virus and cellular proteins, andother components such as lipids and carbohydrates, so as to minimize oreliminate any risk of generating an immune response in the context ofgene transfer. This latter point is especially significant in thecontext of AAV because AAV is a “helper-dependent” virus that requiresco-infection with a helper virus (typically adenovirus) or otherprovision of helper virus functions in order to be effectivelyreplicated and packaged during the process of AAV production; and,moreover, as described above, adenovirus has been observed to generate ahost immune response in the context of gene transfer applications (see,e.g., Le et al., 1997; Byrnes et al., 1995, Neuroscience, 66:1015; McCoyet al., 1995, Human Gene Therapy, 6:1553; and Barr et al., 1995, GeneTherapy, 2:151).

If an rAAV vector is to be packaged in an AAV particle, in order toreplicate and package the rAAV vector, the missing functions arecomplemented with a packaging gene, or a plurality thereof, whichtogether encode the necessary functions for the various missing repand/or cap gene products. The packaging genes or gene cassettes arepreferably not flanked by AAV ITRs and preferably do not share anysubstantial homology with the rAAV genome. Thus, in order to minimizehomologous recombination during replication between the vector sequenceand separately provided packaging genes, it is desirable to avoidoverlap of the two polynucleotide sequences. The level of homology andcorresponding frequency of recombination increase with increasing lengthof the homologous sequences and with their level of shared identity. Thelevel of homology that will pose a concern in a given system can bedetermined theoretically and confirmed experimentally, as is known inthe art. Generally, however, recombination can be substantially reducedor eliminated if the overlapping sequence is less than about a 25nucleotide sequence if it is at least 80% identical over its entirelength, or less than about a 50 nucleotide sequence if it is at least70% identical over its entire length. Of course, even lower levels ofhomology are preferable since they will further reduce the likelihood ofrecombination. It appears that, even without any overlapping homology,there is some residual frequency of generating RCA. Even furtherreductions in the frequency of generating RCA (e.g., by nonhomologousrecombination) can be obtained by “splitting” the replication andencapsidation functions of AAV, as described by Allen et al. in U.S.patent application Ser. No. 08/769,728, filed Dec. 18, 1996.

The rAAV vector construct, and the complementary packaging geneconstructs can be implemented in this invention in a number of differentforms. Viral particles, plasmids, and stably transformed host cells canall be used to introduce such constructs into the packaging cell, eithertransiently or stably.

A variety of different genetically altered cells can thus be used in thecontext of this invention. By way of illustration, a mammalian host cellmay be used with at least one intact copy of a stably integrated rAAVvector. An AAV packaging plasmid comprising at least an AAV rep geneoperably linked to a promoter can be used to supply replicationfunctions (as described in U.S. Pat. No. 5,658,776). Alternatively, astable mammalian cell line with an AAV rep gene operably linked to apromoter can be used to supply replication functions (see, e.g., Trempeet al., U.S. Pat. No. 5,837,484; Burstein et al., WO 98/27207; andJohnson et al., U.S. Pat. No. 5,658,785). The AAV cap gene, providingthe encapsidation proteins as described above, can be provided togetherwith an AAV rep gene or separately (see, e.g., the above-referencedapplications and patents as well as Allen et al. (WO 96/17947). Othercombinations are possible.

As is described in the art, and illustrated in the references citedabove and in Examples below, genetic material can be introduced intocells (such as mammalian “producer” cells for the production of rAAV)using any of a variety of means to transform or transduce such cells. Byway of illustration, such techniques include, but are not limited to,transfection with bacterial plasmids, infection with viral vectors,electroporation, calcium phosphate precipitation, and introduction usingany of a variety of lipid-based compositions (a process often referredto as “lipofection”). Methods and compositions for performing thesetechniques have been described in the art and are widely available.

Selection of suitably altered cells may be conducted by any technique inthe art. For example, the polynucleotide sequences used to alter thecell may be introduced simultaneously with or operably linked to one ormore detectable or selectable markers as is known in the art. By way ofillustration, one can employ a drug resistance gene as a selectablemarker. Drug resistant cells can then be picked and grown, and thentested for expression of the desired sequence (i.e., a product of theheterologous polynucleotide). Testing for acquisition, localizationand/or maintenance of an introduced polynucleotide can be performedusing DNA hybridization-based techniques (such as Southern blotting andother procedures as known in the art). Testing for expression can bereadily performed by Northern analysis of RNA extracted from thegenetically altered cells, or by indirect immunofluorescence for thecorresponding gene product. Testing and confirmation of packagingcapabilities and efficiencies can be obtained by introducing to the cellthe remaining functional components of AAV and a helper virus, to testfor production of AAV particles. Where a cell is inheritably alteredwith a plurality of polynucleotide constructs, it is generally moreconvenient (though not essential) to introduce them to the cellseparately, and validate each step seriatim. References describing suchtechniques include those cited herein.

In one approach to packaging rAAV vectors in an AAV particle, the rAAVvector sequence (i.e., the sequence flanked by AAV ITRs), and the AAVpackaging genes to be provided in trans, are introduced into the hostcell in separate bacterial plasmids. Examples of this approach aredescribed in Ratschin et al., 1984, Mol. Cell. Biol., 4:2072; Hermonatet al., 1984, Proc. Natl. Acad. Sci. USA, 81:6466; Tratschin et al.,1985, Mol. Cell. Biol., 5:3251; McLaughlin et al., 1988, J. Virol.,62:1963; Lebkowski et al., 1988, Mol. Cell. Biol., 7:349; Samulski etal., 1989, J. Virol., 63:3822-3828; and Flotte et al., 1992, Am. J.Respir. Cell. Mol. Biol., 7:349.

A second approach is to provide either the rAAV vector sequence, or theAAV packaging genes, in the form of an episomal plasmid in a mammaliancell used for AAV replication. See, for example, U.S. Pat. No.5,173,414.

A third approach is to provide either the rAAV vector sequence or theAAV packaging genes, or both, stably integrated into the genome of themammalian cell used for replication, as exemplified in Example 2 below.

One exemplary technique of this third approach is outlined ininternational patent application WO 95/13365 (Targeted GeneticsCorporation and Johns Hopkins University) and corresponding U.S. Pat.No. 5,658,776 (by Flotte et al.). This example uses a mammalian cellwith at least one intact copy of a stably integrated rAAV vector,wherein the vector comprises an AAV ITR and a transcription promoteroperably linked to a target polynucleotide, but wherein the expressionof rep is limiting in the cell. In a preferred embodiment, an AAVpackaging plasmid comprising the rep gene operably linked to aheterologous promoter is introduced into the cell, and then the cell isincubated under conditions that allow replication and packaging of therAAV vector sequence into particles.

Another approach is outlined in Trempe et al., U.S. Pat. No. 5,837,484.This example uses a stable mammalian cell line with an AAV rep geneoperably linked to a heterologous promoter so as to be capable ofexpressing functional Rep protein. In various preferred embodiments, theAAV cap gene can be provided stably as well or can be introducedtransiently (e.g. on a plasmid). An rAAV vector can also be introducedstably or transiently.

Another approach is outlined in patent application WO 96/17947 (TargetedGenetics Corporation). This example uses a mammalian cell whichcomprises a stably integrated AAV cap gene, and a stably integrated AAVrep gene operably linked to a helper virus-inducible heterologouspromoter. A plasmid comprising the rAAV vector sequence is alsointroduced into the cells (either stably or transiently). The packagingof rAAV vector into particles is then initiated by introduction of thehelper virus.

Methods for achieving high titers of rAAV virus preparations that aresubstantially free of contaminating virus and/or viral or cellularproteins are outlined by Atkinson et al. in WO 99/11764. Techniquesdescribed therein can be employed for the large-scale production of rAAVviral particle preparations. Other methods for preparing rAAV describedin WO 00/14205, WO 99/20773, and WO 99/20779.

These various examples address the issue of producing rAAV viralparticles at sufficiently high titer, minimizing recombination betweenrAAV vector and sequences encoding packaging components, reducing oravoiding the potential difficulties associated with the expression ofthe AAV rep gene in mammalian cell line (since the Rep proteins can notonly limit their own expression but can also affect cellular metabolism)and producing rAAV virus preparations that are substantially free ofcontaminating virus and/or viral or cellular protein.

Packaging of an AAV vector into viral particles relies on the presenceof a suitable helper virus for AAV or the provision of helper virusfunctions. Helper viruses capable of supporting AAV replication areexemplified by adenovirus, but include other viruses such as herpesviruses (including, but not limited to, HSV1, cytomegalovirus and HHV-6)and pox virus (particularly vaccinia). Any such virus may be used.

Frequently, the helper virus will be an adenovirus of a type andsubgroup that can infect the intended host cell. Human adenovirus ofsubgroup C, particularly serotypes 1, 2, 4, 6, and 7, are commonly used.Serotype 5 is generally preferred.

The features and growth patterns of adenovirus are known in the art.See, for example, Horowitz, “Adenoviridae and their replication”, pp771-816 in “Fundamental Virology”, Fields et al., eds. The packagedadenovirus genome is a linear DNA molecule, linked through adenovirusITRs at the left- and right-hand termini through a terminal proteincomplex to form a circle. Control and encoding regions for early,intermediate, and late components overlap within the genome. Earlyregion genes are implicated in replication of the adenovirus genome, andare grouped depending on their location into the E1, E2, E3, and E4regions.

Although not essential, in principle it is desirable that the helpervirus strain be defective for replication in the subject ultimately toreceive the genetic therapy. Thus, any residual helper virus present inan rAAV virus preparation will be replication-incompetent. Adenovirusesfrom which the E1A or both the E1A and the E3 region have been removedare not infectious for most human cells. They can be replicated in apermissive cell line (e.g., the human 293 cell line) which is capable ofcomplementing the missing activity. Regions of adenovirus that appear tobe associated with helper function, as well as regions that do not, havebeen identified and described in the art (see, e.g., P. Colosi et al.,WO97/17458, and references cited therein).

For example, as described in Atkinson et al. (WO 99/11764), a“conditionally-sensitive” helper virus can also be employed to providehelper virus activity. Such a helper virus strain must minimally havethe property of being able to support AAV replication in a host cellunder at least one set of conditions where it itself does not undergoefficient genomic replication. Where helper virus activity is suppliedas intact virus particles, it is also generally necessary that the virusbe capable of replication in a host cell under a second set ofconditions. The first set of conditions will differ from the second setof conditions by a readily controllable feature, such as the presence orabsence of a required cofactor (such as a cation), the presence orabsence of an inhibitory drug, or a shift in an environmental conditionsuch as temperature. Most conveniently, the difference between the twoconditions is temperature, and such a conditionally-sensitive virus isthus referred to as a temperature-sensitive helper virus.

Helper virus may be prepared in any cell that is permissive for viralreplication. For adenovirus, preferred cells include 293 cells and HeLacells. It is preferable to employ culture techniques that permit anincrease in seeding density. 293 cells and HeLa cell variants areavailable that have been adapted to suspension culture. HeLa ispreferable for reasons of cell growth, viability and morphology insuspension. These cells can be grown at sufficient density (2×10⁶ perml) to make up for the lower replication rate of thetemperature-sensitive adenovirus strain. Once established, cells areinfected with the virus and cultured at the permissive temperature for asufficient period; generally 3-7 days and typically about 5 days.

Examples of methods useful for helper virus preparation, isolation andconcentration can be found in Atkinson et al. (WO 99/11764).

Several criteria influence selection of cells for use in producing rAAVparticles as described herein. As an initial matter, the cell must bepermissive for replication and packaging of the rAAV vector when usingthe selected helper virus. However, since most mammalian cells can beproductively infected by AAV, and many can also be infected by helperviruses such as adenovirus, it is clear that a large variety ofmammalian cells and cell lines effectively satisfy these criteria. Amongthese, the more preferred cells and cell lines are those that can beeasily grown in culture so as to facilitate large-scale production ofrAAV virus preparations. Again, however, many such cells effectivelysatisfy this criterion. Where large-scale production is desired, thechoice of production method will also influence the selection of thehost cell. For example, as described in more detail in Atkinson et al.(WO 99/11764) and in the art, some production techniques and culturevessels or chambers are designed for growth of adherent or attachedcells, whereas others are designed for growth of cells in suspension. Inthe latter case, the host cell would thus preferably be adapted oradaptable to growth in suspension. However, even in the case of cellsand cell lines that are regarded as adherent or anchorage-dependent, itis possible to derive suspension-adapted variants of ananchorage-dependent parental line by serially selecting for cellscapable of growth in suspension. See, for example, Atkinson et al. (WO99/11764).

Ultimately, the helper virus, the rAAV vector sequence, and all AAVsequences needed for replication and packaging must be present in thesame cell. Where one or more AAV packaging genes are provided separatelyfrom the vector, a host cell is provided that comprises: (i) one or moreAAV packaging genes, wherein each said AAV packaging gene encodes an AAVreplication or encapsidation protein; (ii) a heterologous polynucleotideintroduced into said host cell using an rAAV vector, wherein said rAAVvector comprises said heterologous polynucleotide flanked by at leastone AAV ITR and is deficient in said AAV packaging gene(s); and (iii) ahelper virus or sequences encoding the requisite helper virus functions.It should be noted, however, that one or more of these elements may becombined on a single replicon.

The helper virus is preferably introduced into the cell culture at alevel sufficient to infect most of the cells in culture, but canotherwise be kept to a minimum in order to limit the amount of helpervirus present in the resulting preparation. A multiplicity of infectionor “MOI” of 1-100 may be used, but an MOI of 5-10 is typically adequate.

Similarly, if the rAAV vector and/or packaging genes are transientlyintroduced into the packaging cell (as opposed to being stablyintroduced), they are preferably introduced at a level sufficient togenetically alter most of the cells in culture. Amounts generallyrequired are of the order of 10 μg per 10⁶ cells, if supplied as abacterial plasmid; or 10⁸ particles per 10⁵ cells, if supplied as an AAVparticle. Determination of an optimal amount is an exercise of routinetitration that is within the ordinary skill of the artisan.

These elements can be introduced into the cell, either simultaneously,or sequentially in any order. Where the cell is inheritably altered byany of the elements, the cell can be selected and allowed to proliferatebefore introducing the next element.

In one preferred example, the helper virus is introduced last into thecell to rescue and package a resident rAAV vector. The cell willgenerally already be supplemented to the extent necessary with AAVpackaging genes. Preferably, either the rAAV vector or the packaginggenes, and more preferably both are stably integrated into the cell. Itis readily appreciated that other combinations are possible. Suchcombinations are included within the scope of the invention.

Once the host cell is provided with the requisite elements, the cell iscultured under conditions that are permissive for the replication AAV,to allow replication and packaging of the rAAV vector. Culture time ispreferably adjusted to correspond to peak production levels, and istypically 3-6 days. rAAV particles are then collected, and isolated fromthe cells used to prepare them.

Optionally, rAAV virus preparations can be further processed to enrichfor rAAV particles, deplete helper virus particles, or otherwise renderthem suitable for administration to a subject. See Atkinson et al. forexemplary techniques (WO 99/11764). Purification techniques can includeisopynic gradient centrifugation, and chromatographic techniques.Reduction of infectious helper virus activity can include inactivationby heat treatment or by pH treatment as is known in the art. Otherprocesses can include concentration, filtration, diafiltration, ormixing with a suitable buffer or pharmaceutical excipient. Preparationscan be divided into unit dose and multi dose aliquots for distribution,which will retain the essential characteristics of the batch, such asthe homogeneity of antigenic and genetic content, and the relativeproportion of contaminating helper virus.

Various methods for the determination of the infectious titer of a viralpreparation are known in the art. For example, one method for titerdetermination is a high-throughput titering assay as provided byAtkinson et al. (WO 99/11764). Virus titers determined by this rapid andquantitative method closely correspond to the titers determined by moreclassical techniques. In addition, however, this high-throughput methodallows for the concurrent processing and analysis of many viralreplication reactions and thus has many others uses, including forexample the screening of cell lines permissive or non-permissive forviral replication and infectivity.

Methods of Using rAAV of the Invention

The invention also provides methods in which administration of rAAVvectors described herein is used to reduce levels of TNF in a subject.Such methods may be particularly beneficial to individuals with aTNF-associated disorder. Disorders suitable for these methods are thoseassociated with elevated levels of TNF and include, but are not limitedto, arthritis (including RA), psoriatic arthritis, inflammatory boweldiseases (including Crohn's disease and ulcerative colitis), asthma andcongestive heart failure.

The level of TNF may be circulating levels of TNF and/or levels of TNFin a tissue and/or at a particular anatomical site. It is understoodthat TNF levels are reduced when compared to TNF levels of a subjectprior to receiving rAAV encoding a TNF antagonist or when compared toTNF levels of an individual that does not receive rAAV encoding a TNFantagonist. It is understood that TNF levels refers to levels of free(uncomplexed or unbound) or active TNF. Methods to detect TNF levels aredescribed below.

In one embodiment, methods provided herein for reducing levels of TNFinclude administration (delivery) of rAAV vectors (or compositionscomprising the vectors) described herein. In another embodiment, rAAVvectors are administered in conjunction with administration of a TNFantagonist, such as TNFR or anti-TNF antibody. The TNF antagonist,preferably in composition with physiologically acceptable carriers,exicipients or diluents, may be administered by suitable techniquesincluding, but not limited to, intra-articular, intraperitoneal orsubcutaneous routes by bolus injection, continuous infusion or sustainedrelease from implants. As discussed below, the TNF antagonist may alsobe administered directly to the connective tissue, particularly thejoint.

The invention also provides methods in which administration of rAAVvectors described herein (or compositions comprising an rAAV vector(s))is used to reduce an inflammatory response in a subject. Preferably, aninflammatory response is reduced in a connective tissue, including, butnot limited to, synovium, cartilage, ligament and tendon. A preferredanatomical site for reduction of an inflammatory response is an affectedjoint in a subject with arthritis, such as RA. It is understood that aninflammatory response is reduced when compared to an inflammatoryresponse in a subject prior to receiving rAAV encoding a TNF antagonistor when compared to an inflammatory response in an individual that doesnot receive rAAV encoding TNF antagonist.

The invention also provides methods in which administration of rAAVvectors described herein (or compositions comprising an rAAV vector(s))is used to palliate a TNF-associated disorder, including inflammatorydiseases such as arthritis (i.e., an arthritic condition) occuring in asubject. Preferably, an arthritic condition is palliated in a joint,preferably connective tissue which includes, but is not limited to,synovium, cartilage, ligament and tendon. It is understood that anarthritic condition is palliated when compared to an arthritic conditionin a subject prior to receiving rAAV encoding a TNF antagonist or whencompared to an arthritic condition in an individual that does notreceive rAAV encoding TNF antagonist.

In a preferred embodiment, the rAAV vector (or compositions comprisingan rAAV vector(s)) is delivered to an arthritic joint of a mammal thusproviding a source of the TNF antagonist at the site of inflammation.Even more preferably, the rAAV vector comprises a polynucleotideencoding sTNFR(p75):Fc.

In another preferred embodiment, the rAAV vector(s) (or compositionscomprising an rAAV vector(s)) is delivered to an arthritic joint of amammal providing a source of the TNF antagonist and a source of IL-1antagonist at the site of inflammation. Preferably, the rAAV vectorcomprises a polynucleotide encoding sTNFR(p75):Fc and a polynucleotideencoding IL-1R.

In another preferred embodiment, a source of the TNF antagonist and asource of IL-1 antagonist are delivered to an arthritic joint of amammal at the site of inflammation through the administration of atleast two different rAAV vectors (or compositions comprising at leasttwo different rAAV vectors). Preferably, one of the rAAV vectorscomprises a polynucleotide encoding a TNFR and another one of the rAAVvectors comprises a polynucleotide encoding an IL-1R. In these twodifferent rAAV vectors, the heterologous polynucleotides may be operablylinked to transcriptional promoters and/or enhancers which are activeunder similar conditions or to transcriptional promoters and/orenhancers which are active under different conditions, e.g.,independently regulated. In various refinements of administration, thetwo different rAAV vectors (i.e., one comprising a polynucleotideencoding a TNFR and one comprising a polynucleotide encoding IL-1R) maybe administered to the mammal at the same time or at different times, atthe same or at different frequencies and/or in the same or at differingamounts.

For any of the above methods, it is understood that one or more rAAVvectors may be administered. For example, as discussed above, a vectormay be administered that encodes a TNF antagonist, such as TNF receptor(most preferably sTNFR(p75):Fc). Alternatively, an additional vector maybe administered that encodes an IL-1 antagonist, such as an IL-1receptor polypeptide. Alternatively, a single vector encoding both a TNFantagonist and an IL-1 antagonist may be administered. This singlevector may have the coding sequences under control of the same ordifferent transcriptional regulatory elements. If more than one vectoris used, it is understood that they may be administered at the same orat different times and/or frequencies.

Further, it is understood that, for any of the above methods, inpreferred embodiments, the individual receiving rAAV vector(s) will havecells which contain the rAAV vector (after administration), and mostpreferably will have cells in which the rAAV vector(s) is integratedinto the cellular genome. Stable integration of rAAV is a distinctadvantage, as it allows more persistent expression than episomalvectors. Accordingly, in preferred embodiments, cells (i.e., at leastone cell) in the individual will comprise stably integrated rAAV. Statedalternatively, for any of the above methods, administration of rAAV(s)results in integration of the rAAV(s) into cellular genomes (although,as is understood by those in the art, not all rAAV vectors need beintegrated). Methods of determining and/or distinguishing integrated vs.non-integrated forms, such as Southern detection methods, are well knownin art.

Administration of rAAV vectors (preferably packaged as AAV particles)may be through any of a number of routes. A preferred mode ofadministration is through intramuscular delivery. Intramuscular deliveryof the rAAV vectors can reduce TNF levels both in tissue andinter-tissue spaces near the site of injection and also in circulation.Another preferred mode of administration of the rAAV compositions isthrough intravenous delivery. Another preferred mode of administrationof rAAV compositions of the invention is through injection of thecomposition(s) directly to the tissue or anatomical site. A preferredmode of such an administration is by intra-articular injection of thecomposition. Preferably, the rAAV composition is delivered to thesynovium of the affected joint; more preferably, to synovial cellslining the joint space. Administration to the joint can be single orrepeated administrations. Repeated administration would be at suitableintervals, such as about any of the following: once a month, once every6 weeks, once every two months, once every three months, once every fourmonths, once every five months, once very six months. Repeatedadministrations may also occur at varying intervals.

Another preferred mode of administration of rAAV compositions of theinvention is through naso-pharyngeal and pulmonary routes ofadministration including, but not limited to, by-inhalation,transbronchial and transalveolar routes. The invention includes rAAVcompositions suitable for by-inhalation administration including, butnot limited to, various types of aerosols for inhalations, as well aspowder forms for delivery systems. Devices suitable for by-inhalationadministration of rAAV compositions include, but are not limited to,atomizers and vaporizers.

An effective amount of rAAV (preferably in the form of AAV particles) isadministered, depending on the objectives of treatment. An effectiveamount may be given in single or divided doses. Where a low percentageof transduction can achieve a therapeutic effect, then the objective oftreatment is generally to meet or exceed this level of transduction. Insome instances, this level of transduction can be achieved bytransduction of only about 1 to 5% of the target cells, but is moretypically about 20% of the cells of the desired tissue type, usually atleast about 50%, preferably at least about 80%, more preferably at leastabout 95%, and even more preferably at least about 99% of the cells ofthe desired tissue type.

As an guide, the number of rAAV particles administered per injectionwill generally be between about 1×10⁶ and about 1×10¹⁴ particles,preferably, between about 1×10⁷ and 1×10¹³ particles, more preferablyabout 1×10⁹ and 1×10¹² particles and even more preferably about 1×10¹¹particles.

The number of rAAV particles administered per joint by intra-articularinjection, for example, will generally be at least about 1×10⁸, and ismore typically about 5×10⁸, about 1×10¹⁰, and on some occasions about1×10¹¹ particles, including both DNAse resistant and DNAse susceptibleparticles. In terms of DNAse resistant particles, the dose willgenerally be between about 1×10⁶ and about 1×10¹⁴ particles, moregenerally between about 1×10⁸ and about 1×10¹² particles.

The number of rAAV particles administered per intramuscular injectionand per intravenous administration, for example, will generally be atleast about 1×10¹⁰, and is more typically about any of the following:5×10¹⁰, 1×10¹¹, 5×10¹¹, 1×10¹², 5×10¹² and on some occasions about1×10¹³ particles, including both DNAse resistant and DNAse susceptibleparticles. In terms of DNAse resistant particles, the dose willgenerally be between about 1×10⁶ and about 1×10¹⁴ particles, moregenerally between about 1×10¹⁰ and 1×10¹³ particles.

The effectiveness of rAAV delivery can be monitored by several criteria.For example, samples removed by biopsy or surgical excision may beanalyzed by in situ hybridization, PCR amplification usingvector-specific probes and/or RNAse protection to detect rAAV DNA and/orrAAV mRNA. Also, for example, harvested tissue, joint fluid and/or serumsamples can be monitored for the presence of TNF antagonist encoded bythe rAAV with immunoassays, including, but not limited to,immunoblotting, immunoprecipitation, immunohistology and/orimmunofluorescent cell counting, or with function-based bioassaysdependent on TNF antagonist-mediated inhibition of TNF activity. Forexample, when the rAAV encoded TNF antagonist is a TNFR polypeptide, thepresence of the encoded TNFR in harvested samples can be monitored witha TNFR immunoassay or a function-based bioassay dependent onTNFR-mediated inhibition of TNF killing of mouse L929 cells. Examples ofsuch assays are known in the art and described herein.

The invention also provides methods in which administration of rAAVvectors described herein use ex vivo strategies for delivery ofpolynucleotides to the mammal. Such methods and techniques are known inthe art. See, for example, U.S. Pat. No. 5,399,346. Generally, cells aretransduced by the rAAV vectors in vitro and then the transduced cellsare introduced into the mammal, for example, into an arthritic joint.Suitable cells are known to those skilled in the art and includeautologous cells, such as stem cells.

The effectiveness of the methods provided herein may, for example, bemonitored by assessment of the relative levels of TNF in harvestedtissue, joint fluid and/or serum subsequent to delivery of the rAAVvectors described herein. Assays for assessing TNF levels are known inthe art and include, but are not limited to, immunoassays for TNF,including, but not limited to, immunoblot and/or immunoprecipitationassays, and cytotoxicity assays with cells sensitive to the cytotoxicactivity of TNF. See, for example, Khabar et al., 1995, Immunol. Lett.46:107-110.

The treated subject may also be monitored for clinical features whichaccompany the TNF-associated disorder. For example, subjects may bemonitored for reduction is symptoms associated with inflammation. Forexample, after treatment of RA in a subject using methods of the presentinvention, the subject may be assessed for improvements in a number ofclinical parameters including, but not limited to, joint swelling, jointtenderness, morning stiffness, pain, erythrocyte sedimentation rate, andc-reactive protein.

The selection of a particular composition, dosage regimen (i.e., dose,timing and repetition) and route of administration will depend on anumber of different factors, including, but not limited to, thesubject's medical history and features of the condition and the subjectbeing treated. The assessment of such features and the design of anappropriate therapeutic regimen is ultimately the responsibility of theprescribing physician. The particular dosage regimen may be determinedempirically.

The foregoing description provides, inter alia, compositions and methodsfor reducing the levels of TNF in a mammal. It is understood thatvariations may be applied to these methods by those of skill in this artwithout departing from the spirit of this invention.

The examples presented below are provided as a further guide to apractitioner of ordinary skill in the art, and are not meant to belimiting in any way.

EXAMPLES Example 1 Rat (P80) TNFR:FC Fusion Constructs and Expression ofSame

Cloning the Rat (p80) TNFR Extracellular Domain (ECD)

cDNA encoding the extracellular domain (EDC) of the rat p80 TNFR (TypeII) was isolated from MARATHON-READY rat spleen cDNA (Clontech) using 5′RACE PCR (Clontech) with a gene-specific PCR primer(5′-CTAACGACGTTAACGATGCAGGTGAC-3′) (SEQ ID NO: 15) (Frohman et al.,1988, Proc. Natl. Acad. Sci. USA 85:8998-9002). This primer was selectedfrom the 259 bp sequence of the cytoplasmic region of the rat TNFR (p80)gene (Bader et al., 1996, J. Immunol. 157:3089-3096). Five separate 5′RACE PCR reactions were performed. The products from each PCR reactionwere ligated into pCR 2.1 plasmid (Invitrogen Corporation) followed bytransformation into TOP10F′ competent cells, using the TOPO TA Cloning®Kit (Invitrogen Corporation). A representative panel of clones werecompletely sequenced and a full consensus sequence of the rat TNFR (p80)ECD was generated. The cDNA sequence and the amino acid sequence aredepicted in FIG. 1. DNA and protein sequence alignments were carried outusing the murine p80 TNFR and the human p75 TNFR as reference sequences.FIGS. 2A and 2B depicts a protein alignment of the rat p80 TNFR ECD, themurine p80 TNFR ECD and the human p75 TNFR ECD. The rat TNFR (p80) ECDplasmid was denoted pCRrTNFR.ECD.

Cloning the Rat IgG1 Fc Region

Rat spleen poly(A) RNA was reverse transcribed with Oligo d(T)₁₆ as aprimer and the IgG1 Fc cDNA (encompassing the hinge, CH2 and CH3domains) was subsequently amplified using the GeneAmp

RNA PCR Kit (Perkin Elmer) (FIG. 3). PCR primers were designed based onthe rat IgG1 sequence (GenBank RAT IGG1Z, Accesion # M28670)(Bruggemann, 1988, Gene 74:473-82). The forward (hinge region) primer:5′-cggaattcGTGCCCAGAAACTGTGGAG-3′ (SEQ ID NO: 16) included an EcoRi site(lower case). The reverse (CH3 region) primer:5′-gctctagaTCATTTACCCGGAGAGTGG-3′ (SEQ ID NO: 17) included an XbaI site.The PCR product was ligated to pCR 2.1 plasmid DNA followed bytransformation into TOP10FF′ competent cells, using the TOPO TA Cloning®Kit (Invitrogen Corporation). A panel of clones were analyzed byrestriction enzyme and sequence analyses. The cDNA sequence of the ratIgG1Fc and the corresponding amino acid sequence is depicted in FIG. 4.One clone was used for further manipulations (see below) and was denotedpCRrIgG1Fc.

Generation of Rat (p80) TNFR-Fc Fusion Construct and Expression Vector

To facilitate the fusion of the rat TNFR ECD with the IgG1Fc region (atthe hinge region), PCR was used to engineer a NotI restriction site atthe 5′ end and a KpnI restriction site at the 3′ end of the TNFR ECD.For the PCR reactions, plasmid pCRrTNFR.ECD was used as a template, theforward primer (p80-5 NotI) was 5′-CATAAGGGCCCGCAAGAGCGG GAGCTACCGCCG-3′(SEQ ID NO: 18) and the reverse primer (p80-3 KpnI) was5′-GGTACCCCACCCGTGATGCTTGGTTCAATG-3′ (SEQ ID NO: 19). Similarly, PCR wasused to engineer a KpnI restriction site at the 5′ end of the IgG1Fc (atthe hinge region). For this, pCRrIgG1Fc was used as a template, theforward primer (5r IgG1 Fc) was 5′-GGGTACCCAGAAACTGTGGAGGTGATTGC-3′ (SEQID NO: 20) and the reverse primer (HBRATG1/3′) was5′-GCTCTAGATCATTTACCCGGAGAGTGG-3′ (SEQ ID NO: 17).

The site of the sequence fusion was modeled after the human (p75)TNFR:Fcfusion protein (Mohler et al., 1993, J. Immunol. 151:1548-1561). TheTNFR ECD and IgG1Fc PCR products were ligated via their KpnI restrictionsites and subcloned into pCR 2.1. A panel of clones were analyzed byrestriction enzyme and sequence analyses. One plasmid with the fusionpolynucleotide (pCRrTNFR-Fc) was used for further manipulations. Thenucleotide sequence of the rat TNFR:Fc fusion polynucleotide and theencoded amino acid sequence are depicted in FIG. 5.

To construct a mammalian expression vector, the plasmid pCRrTNFR-Fc wasdigested with NotI restriction enzyme and a 1.6 kb DNA fragmentcontaining the rTNFR-Fc fusion gene was isolated and purified. Themammalian expression plasmid pCMVβ (Clontech) was digested with NotI toremove the β-galactosidase gene and the 3.6 kb plasmid DNA backbonefragment was isolated and purified. The 1.6 kb rTNFR-Fc gene fragmentwas ligated to the 3.6 kb plasmid backbone and the resulting expressionplasmid was designated pCMVrTNFR-Fc (diagrammed in FIG. 6).

Analysis of Expression from pCMVrTNFR-Fc

The expression plasmid pCMVrTNFR-Fc (10 μg) was transfected into 293Acells using LIPOFECTAMINE (Life Technologies). A mock-transfection wasincluded as a negative control. At 48 hours post-transfection, cellswere harvested and total cellular RNA was extracted using the RneasyMini Kit (Qiagen). RNA samples (10 μg) were subjected to northern blotanalysis using a rat TNFR-specific ³²P-labeled probe. A 1.6 kb bandcorresponding to the rat TNFR-Fc RNA was present only in the RNA samplefrom pCMVrTNFR-Fc-transfected cells (FIG. 7).

To assess protein expression from the rat TNFR-Fc expression vector, 293cells in 60 mm dishes were transfected with 10 μg of either pCMVrTNFR-Fcor a control plasmid (pCMVGFP) using LIPOFECTAMINE (Life Technologies).A mock-transfection was also included. At 48 hours post-transfection,cells were washed with PBS and fixed for 10 min in methanol/acetone atroom temperature. The cells were then washed with PBS, incubated withblocking buffer for 1 hour at room temperature, washed again with PBSand then incubated with alkaline phosphatase-conjugated anti-rat IgG1(diluted 1:5000 in PBS) for 1 hour at 37° C. The cells were washed withPBS and were incubated with the alkaline phosphatase detection system1-STEP NBT/BCIP plus Suppressor (PIERCE) for 2 to 4 hours at roomtemperature.

Example 2 Generation of rAAV Vectors and Producer Cell Lines

rAAV Vectors

The principles of rAAV vector construction follow from the genetics ofthe virus. Generally, the AAV rep and cap genes are deleted and thecis-acting ITR sequences are retained in the construction of an rAAVvector. Rep and cap functions can be provided by a variety approachesincluding, but not limited to, those based on transient transfections(see, for example, Samulski et al., 1989; Flotte et al., 1995, GeneTher. 2:29-37) and those based on stable cell lines (see, for example,Clark et al., 1995, Hum. Gene Ther. 6:1329-1341; Tamayose et al., 1996,Hum. Gene Ther. 7:507-513) to allow for rAAV virus generation.

Construction of the AAV vector plasmid pAAVCMVrTNFR-Fc

The expression plasmid pCMVrTNFR-Fc DNA was digested with NotI and Xbalrestriction enzymes and the 1.6 kb DNA fragment containing the ratTNFR-Fc fusion gene was isolated and purified. An rAAV vector plasmid,pAAVflagLUC, was digested with NotI and XbaI restriction enzymes toremove the flagLUC DNA fragment and the rAAV vector backbone wasisolated and purified. The 1.6 kb rat TNFR-Fc gene fragment was thensubcloned into the NotI and XbaI restriction sites of the rAAV vectorplasmid. The diagram in FIG. 8 depicts the resulting rAAV vector inwhich the rat TNFR-Fc fusion polynucleotide is located between, andoperably linked to, the human immediate early CMV enhancer promoter anda synthetic polyA addition signal. The transcription unit containing theTNFR-Fc fusion gene is enclosed between the AAV-2 ITRs. This rAAV vectorplasmid was denoted pAAVCMVrTNFR-Fc.

Generation of a Stable Producer Cell Line for AAVCMVrTNFR-Fc

Generally, rAAV producer cell lines are generated by transfection ofcells with vector plasmid, followed by selection with antibiotics(typically G418, hygromycin, or histidinol) and cloning of individualcolonies. Colonies are first screened for vector replication. Clonesshowing high level replication of vector following adenovirus infectionare then tested for production of infectious vector.

Plasmid pAAVCMVrTNFR-Fc (30 μg) was transfected into the Hela C12packaging cell line by electroporation (Potter et al., 1984, Proc. Natl.Acad. Sci. USA 79:7161-7165). The C12 cell line contains the AAV2 repand cap genes that are transcriptionally quiescent until induction uponinfection with adenovirus helper (Clark et al., 1995; Clark et al.,1996, Gene Therapy 3:1124-1132). Twenty four hours post-transfection,the cells were trypsinized and replated in 100 mm plates at densitiesranging from 5×10³ to 5×10⁴ cells per plate. The cells were subjected toselection in DMEM containing 10% fetal bovine serum and 300 μg/mlhygromycin B. Drug-resistant cell clones were isolated, expanded andtheir ability to produce infectious AAVCMVrTNFR-Fc vectors was testedand compared in an infectivity assay as described in Atkinson et al.,1998, Nucleic Acid Res. 26:2821-2823. One such producer cell clone(C12-55) was further used for production of AAVCMVrTNFR-Fc vector.Production, purification and titration were carried out essentially asdescribed herein and as generally described in Atkinson et al. (WO99/11764).

Example 3 Rat TNFR-Fc as a TNF Antagonist

Expression of Rat TNFR-Fc Activity After Transfection with pCMVrTNFR-Fc

Cells were transfected with the rat TNFR-Fc expression vector todetermine (1) whether rat TNFR-Fc would be secreted from cells and (2)whether rat TNFR-Fc had the ability to neutralize TNF-α activity.

293 cells (2×10⁶) in T-75 flasks were transfected with either 10 μg ofpCMVrTNFR-Fc or pCMVGFP using LIPOFECTAMINE (Life Technologies, Inc.).After 48 hours, the medium was collected and tested in a TNF-αinhibition bioassay as follows. Mouse fibrosarcoma WEHI-13var cells(ATCC, CRL-2148) were seeded in 96-well microplate at 4×10⁴ cells perwell in 100 μl RPMI 1640 medium containing 10% fetal bovine serum. Afterovernight incubation, actinomycin D (1 μg/ml) and recombinant rat TNF-α(0.75 ng/ml; BioSource International, PRC 3014) were added to each wellin a total volume of 100 μl. Samples of medium from the transfected 293cells were added to the first row of wells and serially diluted 2-fold,in triplicate. The cells were incubated overnight at 37° C. supplementedwith 5% CO₂. The next day, 50 μl of XTT labeling mixture (Cellproliferation kit, Boehringer Mannheim, #1-465-015) was added to eachwell, and the cells were incubated at 37° C. for 4 hours. Finally, theplate was placed in Spectra MAX 250 plate reader (Molecular Devices) andthe absorbance at 490 nm was recorded using Delta Soft analysissoftware. The absorbance measured directly correlates to the cell numberand thus, to cell proliferation in the assay. If not inhibited, TNF-αinduces cell death in this assay.

Results from such a TNF inhibition bioassay are depicted in FIG. 9 anddemonstrate that pCMVrTNFR-Fc-transfected 293 cells expressed andsecreted the rat TNFR-Fc fusion protein into the medium and that thisTNFR-Fc protein inhibited killing of WEHI-13var cells by TNF-α in adose-dependent manner. Medium from pCMVGFP-transfected 293 cellsappeared to have no effect on TNF-α activity.

Rat TNFR-Fc Activity After Transduction with AAVCMVrTNFR-Fc

Cells were infected with the rAAV virus particles to determine whethertransduced cells could express and secrete rat TNFR-Fc. The rat TNFR-Fcproduced from the transduced cells was also tested for the ability toact as a TNF antagonist.

293 cells in a 24-well plate were mock-infected, infected with a LacZgene-containing AAV vector (Clark et al., 1995; Clark et al., 1996) orwith AAVCMVrTNFR-Fc at 10⁴ particles per cell. The infected cells weremaintained in DMEM containing 10% fetal bovine serum (1 ml per well).Forty eight hours post-infection, the media was collected and samplesranging from 0.3125 μl to 20 μl were analyzed in a TNF-α inhibitionassay, as described above. 293 cells transduced with AAVCMVrTNFR-Fc, butnot cells transduced with the LacZ gene-containing vector (D6) normock-infected cells, expressed and secreted a TNFR-Fc polypeptide withTNF-α neutralizing activity (FIG. 10).

In another experiment, 293 cells were either mock-infected or infectedwith AAVCMVrTNFR-Fc vector at 10², 5×10², 10³, 5×10³ and 10⁴ particlesper cell. At 48 hours post-infection, the media were collected andsubjected to a TNF-α inhibition assay as described above. The ratTNFR-Fc protein was secreted from transduced cells in a dose-dependentmanner (FIG. 11). Time-course analysis of TNFR-Fc protein expressionafter transduction of 293 cells with AAVCMVrTNFR-Fc at 10³ particles percell showed a steady increase in secretion of a TNFR-Fc protein withTNF-α antagonist activity over 120 hours (FIG. 12).

Example 4 rAAV Vector Delivery to Joints

AAV vectors have been shown to mediate efficient and persistent genedelivery to a variety of tissue targets in vivo. These targets haveincluded airway epithelium, vasculature, muscle, liver, and centralnervous system. See, for example, Flotte et al., 1993, Proc. Natl. Acad.Sci. USA 90:10613-10617; Lynch, et al., 1997, Circ. Res. 80:497-505;Kessler et al., 1996, Proc. Natl. Acad. Sci. USA 93:14082-14087; Xiao etal., 1996, J. Virol. 70:8098-8108; Koeberl et al., 1997, Proc. Natl.Acad. Sci. USA 94:1426-1431; Snyder et al., 1997, Nat. Genet.16:270-276; and Kaplitt et al., 1994, Nat. Genet. 8:148-154. In severalcases, expression of a reporter transgene delivered with an rAAV vectorhas been documented for greater than one year. Animal studies with theAAV vector system have in general shown little or no pathogenicity orimmunogenicity, in contrast to other viral vector systems.

In a pilot study, 5 normal rats were injected in the hind paw jointswith 10¹¹ DNase resistant particles (DRP) of an rAAV containing the LacZgene, rAAV-LacZ. Detection of incorporation of the rAAV vector into thegenome would be monitored by the production of the LacZ encodedpolypeptide, β-galactosidase. The rats were observed for 30 days forindications of inflammation such as joint redness, swelling and pain. Noindication of inflammation was seen in these animals in contrast to ratsinjected with M. tuberculosis in incomplete Freund's adjuvant whichdeveloped overt inflammation as indicated by joint swelling, redness,tenderness.

The animals were sacrificed at day 30, the joints examined and jointtissue scraped for assessment of gene expression by luminescence readoutof β-galactosidase activity. No gross inflammation was seen, the jointsappeared identical to uninjected joints, in contrast with adjuvantinjected rats which exhibited marked cellularity. Luminescencemeasurement showed 52×10⁴ RLU in the rAAV injected joint while thebackground level was 3.5×10⁴ RLU. Despite the high background ofendogenous β-galactosidase found in joint tissue, the results of thisexperiment indicate that rAAV vectors are capable of successfullytransducing cells found in the joint.

In summary, preliminary experiments in normal rats suggest that rAAVvectors mediates the transduction of cells found in proximity to thejoint space following intra-articular injection of vector.

Example 5 rAAV Vector Delivery to Joints in a Rodent Model of Arthritis

A study was conducted using rAAV vector gene transfer in thestreptococcus cell wall model of arthritis. The rat model used in thesestudies is an art-accepted and FDA-accepted model for studying arthritisand is used for evaluating anti-cytokine therapies.

In this study, rats treated with intraperitoneal injection of Group Astreptococcus cell wall to induce arthritis were also co-administered anintra-articular injection of 8.6×10⁹ DRP of rAAV-LacZ vector. Animalswere sacrificed on day 5 following vector administration. Rats thatreceived the streptococcal cell wall preparation developed arthritisirrespective of rAAV-LacZ vector administration.

Histochemical staining for β-galactosidase activity resulted in thepresence of β-galactosidase activity (blue reaction product) inrAAV-LacZ treated (FIGS. 13 and 14) but not control treated (FIG. 15)joints. Very dark blue-black cells were seen in synovium of rAAV-LacZtreated animals and lighter blue cells were localized to the bone stromaunderlying the joint space. At this time point, neither the cartilagenor cancellous bone appeared to be transduced by the vector.

In summary, preliminary experiments in a rat model of arthritis suggestthat rAAV vectors mediates the transduction of cells found in proximityto the joint space following intra-articular injection of vector.

Example 6 rAAV-RatTNFR:Fc Vector Gene Therapy in Rodent Model ofArthritis

Vectors. Recombinant AAV-ratTNFR:Fc (see above examples) and AAV-EGFPvectors were produced from their corresponding stable HeLa C12 producercell lines, C12/AAV-ratTNFR:Fc and C12/AAV-EGFP, respectively. AAV-EGFPencodes the red-shifted enhanced green fluorescent protein (EGFP) formthe bioluminescent jellyfish Aequorea victoria (Heim et al., 1995,Nature 373:663-664; Cormack et al., 1996, Gene 173:33-38). This genecassette includes a CMV immediate-early (IE) enhancer/promoter and abovine growth hormone (BGH) polyadenylation (poly A) signal. It wasincluded in the experiments as vector control (unrelated gene). Cellswere grown in cell factories and vectors were produced from lysatesprepared 3 days after infection with helper Ad5 (moi 10). Cell lysateswere microfluidized through an 18 gauge orfice at 10,000 PSI. The vectorwas then banded by CsCl gradient centrifugation, dialyzed and furtherpurified through a PI column. Finally, the purified vector bulk wasdialyzed against Ringer's buffer saline solution (RBSS) plus 4%Glycerol, sterile filtered, aliquated and stored at −80° C. DNaseI-Resistant Particle (DRP) titers were determined by slot blot analysesand were 7.6×10¹¹DRP/mL and 2.8×10¹² DRP/mL for AAV-ratTNFR:Fc andAAV-EGFP vectors, respectively. Clark et al., 1995, Human Gene Therapy6:1329-1341. Infectious titers were determined by infectious centerassays and were 1×10¹⁰ i.u/mL and 5.2×10⁹ i.u./mL for AAV-ratTNFR:Fc andAAV-EGFP vectors, respectively. Yakobson et al., 1987, J. Virol.61:972-981; Zolotukhin et al., 1999, Gene therapy 6:973-985.

SCW-induced arthritis model. In this experimental model of arthritis,the disease was initiated by a single intraperitoneal (i.p.) injectionof group A SCW peptidoglycan-polysaccharide (PG-APS) (30 μg/gr bodyweight) (Lee Laboratories Inc., Grayson, Ga.) into 4-week old (100 gr)genetically susceptible female Lewis rats (Charles River BreedingLaboratories, Wilmington, Ma.) (Cromartie, et al., 1977, J. Exp. Med.146:1585-1602). Typically, this model exhibits a peripheral andsymmetrical, biphasic polyarthritis with cycles of exacerbatedrecurrence and remission and is clinically and histologically similar toRA (Cromartie, et al., 1977). An acute inflammation of the rear anklesdeveloped within 24-48 hours, which persisted for 4-5 days, and thenpartially resolved. This acute, neutrophil-predominant, inflammatoryresponse was then followed by a spontaneously reactivating chronicinflammation at approximately day 15, which developed into a chronic,progressive, erosive synovitis. In addition to polyarthritis, thisPG-APS model induced chronic granulomatous inflammation of the liver andspleen. The severity of arthritis (articular index, AI) was determinedby scoring each ankle based on the degree of swelling, erythema, anddistortion on a scale of 0-4 and summing the scores for all limbs.

Intra-muscular and intra-articular injections. Rats were anaesthetizedwith Isoflurane (5% with O₂ for induction and 3% for maintenance).Twenty microliters of either AAV-ratTNFR or AAV-EGFP vectors (2×10¹⁰DRP) or an equivalent volume of RBSS plus 4% Glycerol (vehicle) wereinjected into the rear ankle joint using a 30-gauge needle adapted to aHamilton syringe. Intra-muscular injections of either vehicle orrecombinant AAV vectors (1.2×10¹¹ DRP in 150 μL) were carried out usinga 25-gauge needle.

TNFR:Fc bioassay. Blood samples (300 μL) were collected from tail-veinbefore (pre-bleed), and 5 (acute phase), 11 (remission) and 33 (chronicphase) days after SCW-injection. Serum samples (50 μL) were assayed forbioactive rat TNFR:Fc fusion protein in a standard TNF-α bioassayadapted for inhibition studies (Khabar et al., 1995, Immunol. Lett.46:107-110). In this assay, inhibition of TNF-α (750 pg/mL)-mediatedkilling of sensitive WEHI-13VAR cells by soluble rat TNFR:Fc isdetermined by increased absorbance at OD490 nm.

Summary. We evaluated AAV-ratTNFR:Fc vector gene therapy in anexperimental rat model of arthritis. The streptococcal cell wall(SCW)-induced arthritis model in Lewis rats was employed to evaluate theeffect of AAV-ratTNFR:Fc vector administration on the severity ofarthritis on both the ipsilateral and the contralateral joints.

Intra-peritoneal injection of SCW followed by a single intra-articularadministration of 2×10¹⁰ DNase I-resistant particles (DRP) ofAAV-ratTNFR:Fc vector to both rear ankle joints resulted in significantreduction of hind paw swelling as measured by arthritis index (AI)scores. Moreover, intra-peritoneal injection of SCW followed byadministration of AAV-ratTNFR:Fc vector to a single joint also resultedin significant reduction of paw swelling in the contralateral joint. Asingle intra-muscular administration of 1.2×10¹¹ DRP of AAV-ratTNFR:Fcvector resulted in a similar effect. As expected, intra-peritonealinjection of SCW followed by intra-articular or intra-muscularadministration of an AAV vector encoding an unrelated gene expressioncassette (AAV-EGFP) did not exacerbate joint inflammation but also didnot result in any therapeutic effect. Bioactive rat TNFR:Fc protein wasreadily detectable at day 33 in serum samples of rats injectedintra-muscularly with AAV-ratTNFR:Fc vector. In contrast, serumbioactive rat TNFR:Fc protein levels in intra-articularly-injected ratswere not significantly different from control rats (RBSS orAAV-EGFP-treated rats), suggesting that local administration ofAAV-ratTNFR:Fc vector does not lead to significant systemic exposure ofthis TNF-α antagonist.

Results. The experiments described below were carried out using thegroup A SCW-induced arthritis model in rats. A total of 65 four-week oldfemale Lewis rats were divided into 3 groups and treated as follows:

Group 1

-   N=8, Day 0: SCW (i.p.) and AAV-ratTNFR:Fc (intra-articular, both    rear ankles; 2×10¹⁰ DRP/joint)-   N=8, Day 0: SCW (i.p.) and AAV-ratTNFR:Fc (intra-articular, one rear    ankle joint; 2×10¹⁰ DRP/joint)-   N=4, Day 0: SCW (i.p.) and AAV-ratTNFR:Fc (intra-muscular; 1.2×10¹¹    DRP/muscle)-   N=6, Day 0: SCW (i.p.) and AAV-EGFP (intra-articular, both rear    ankles; 2×10¹⁰ DRP/joint)-   N=4, Day 0: SCW (i.p.) and AAV-EGFP (intra-muscular; 1.2×10¹¹    DRP/muscle)    Group 2-   N=4, Day 0: SCW (i.p.) and RBSS (intra-articular, both rear ankles)-   N=5, Day 0: SCW (i.p.)    Group 3-   N=4, Day 0: AAV-ratTNFR:Fc (intra-articular, both rear ankles;    2×10¹⁰ DRP/joint)-   N=4, Day 0: AAV-ratTNFR:Fc (intramuscular; 1.2×10¹¹ DRP/muscle)-   N=4, Day 0: AAV-EGFP (intra-articular, both rear ankles; 2×10¹⁰    DRP/joint)-   N=4, Day 0: AAV-EGFP (intra-muscular; 1.2×10¹¹ DRP/muscle)-   N=3, Day 0: RBSS (intra-articular, both rear ankles)

Rats were inspected daily for disease onset and progression, and theseverity of arthritis (Al) was recorded every 2 to 3 days. FIG. 19 showsthat intra-peritoneal injection of arthritogenic dose (30 μg/gr bodyweight) of SCW on Day 0 either alone or in combination withintra-articular administration of RBSS into both rear ankle jointsresulted in a typical acute inflammatory response that peaked on day 4(mean AI=6) and then decreased to its minimum by day 11 (mean AI=2).Remission was followed by recurrence of joint swelling that plateaued byday 22 (mean AI=7) and remained chronic until the animals weresacrificed (day 35). As expected, intra-peritoneal injection of SCWfollowed by a single intra-articular administration of 2×10¹⁰ DRP ofAAV-ratTNFR:Fc vector to both rear ankle joints did not have asignificant affect on joint swelling during the acute phase. Incontrast, the effect of the latter treatments resulted in significantreduction of hind paw swelling during the chronic phase as measured byAI scores (mean AI=2). Interestingly, administration of AAV-ratTNFR:Fcvector to one joint produced significant and similar therapeutic effectson both the ipsilateral as well as the contralateral joint (see alsoFIG. 20). FIG. 20 shows that animals were injected intra-peritoneallywith SCW (30 μg/gr body weight) on day 0 followed by a singleadministration of AAV-ratTNFR:Fc (total of 2×10¹⁰ DRP) into the leftrear ankle joint. The AI scores for each rear ankle paw was separatelyrecorded. A single intramuscular administration of 1.2×10¹¹ DRP ofAAV-ratTNFR:Fc vector following intra-peritoneal injection of SCWresulted in a similar effect. Intra-peritoneal injection of SCW followedby intra-articular or intra-muscular administration of an AAV vectorencoding the green fluorescent gene (AAV-EGFP) did not exacerbate jointinflammation but also did not result in any therapeutic effect. Finally,administration of either AAV-ratTNFR:Fc or AAV-EGFP to naive rat jointsdid not induce visible joint swelling. From this experiment we concludedthat administration of AAV-ratTNFR:Fc but not AAV-EGFP vector either tothe joint or to the muscle results in production of therapeutic levelsof soluble bioactive rat TNFR:Fc protein that binds and significantlyinhibit the inflammatory activity of TNF-α. Although administration ofAAV-EGFP vector did not result in any therapeutic effect, it did notexacerbate the inflammatory process in the affected joints, and did notinduce inflammation in the joints of naive animals, indicating thatrecombinant AAV vector delivery locally to the joint is safe. Onepossible explanation for the noted contralateral effect is thatexpression of the rat TNFR:Fc gene in transduced joint tissue leads tosecretion of this protein to the circulation which then gains access touninjected inflamed joints. To test this hypothesis, serum samples fromboth naive and SCW-treated animals were assayed for bioactive ratTNFR:Fc protein in a TNF-α inhibition bioassay (Khabar et al., 1995)after administration of AAV-ratTNFR:Fc to the joint or to the muscle.FIGS. 21 and 22 show that bioactive rat TNFR:Fc protein was readilydetectable by day 33 after intra-muscular administration ofAAV-ratTNFR:Fc vector. In contrast, the circulating levels of bioactiverat TNFR:Fc protein from intra-articularly injected animals were low andnon-significantly different from those of control animals (AAV-EGFP orRBSS-treated rats). We concluded that the contralateral effect isunlikely due to secretion and systemic distribution of the rat TNFR:Fcprotein.

Discussion. We described here an in vivo study using an art-acceptedmodel of arthritis aimed at evaluating recombinant AAV-mediated TNFR:Fcgene delivery for the treatment of inflammatory joint disease. Weemployed the SCW-induced arthritis model in rats to evaluate thetherapeutic effect of local (intra-articular) and systemic(intramuscular) administration of AAV-ratTNFR:Fc vector on the severityof arthritis.

Our results show that intra-articular administration of AAV-ratTNFR:Fcvector significantly reduced the severity of SCW-induced arthritis inthe absence of detectable bioactive rat TNFR:Fc protein in thecirculation. Intra-muscular administration of AAV-ratTNFR:Fc vector wasalso effective in reducing arthritis symptoms and as expected bioactiverat TNFR:Fc protein was readily detectable in the serum.

Administration of AAV-ratTNFR:Fc or AAV-EGFP to the joints of naive ratsdid not induce a detectable inflammatory response in the injected pawsand intra-articular administration of AAV-EGFP vector to SCW-treatedrats did not exacerbate the inflammatory joint disease, indicating thatlocal intra-articular administration of recombinant AAV vectors is safe.

Interestingly, a single administration of this vector to one jointresulted in a similar therapeutic effect on both the ipsilateral and theuninjected contalateral joint. The phenomenon of a therapeuticcontralateral effect was first reported by Ghivizzani et al. (1998,Proc. Natl. Acad. Sci. USA 95:4613-4618) who noted that adenoviraldelivery of soluble interleukin 1 receptor (IL-1sR) to one knee joint ofrabbits with bilateral antigen-induced arthritis suppressed disease inboth the ipsilateral as well as the contralateral uninjected knee. Asimilar phenomenon has been noted in this model using the viralinterleukin 10 (vIL-10) gene (Lechman, 1999, MS Thesis, University ofPittsburgh). Moreover, adenoviral delivery of vIL-10 to the paws of micewith collagen-induced arthritis (CIA) (Whalen et al., 1999, J Immunol.162:3625-32) and delivery of IkB to the ankle joints of rats withSCW-induced arthritis (Miagkov et al., 1998, Proc. Natl. Acad. Sci. USA95:13859-13864) also suppressed disease in non-injected joints on thesame animal. One possible explanation for this contralateral effect isthat expression of the rat TNFR:Fc gene in transduced joint tissue leadsto secretion of this protein to the circulation which then gains accessto uninjected inflamed joints. Our results indicate that thecontralateral effect is unlikely due to secretion and systemicdistribution of the rat TNFR:Fc protein. These results are alsoconsistent with those of Ghivizzani et al. (1998) who ruled out thelikelihood that the gene product or even the adenoviral vector travelsto the other joints via systemic circulation or the lymphatics. Thus,our results are most likely consistent with a model that suggests thatdirect introduction of genes into an arthritic joint leads to thetransduction of cells with the ability to traffic to other joints(Ghivizzani et al., 1998).

The circulating levels of bioactive rat TNFR:Fc protein in naive animals(injected intramuscularly with AAV-ratTNFR:Fc vector) were significantlyhigher than in the corresponding SCW-treated animals. The possibleexplanation for this difference is that in SCW-treated animals, thelevels of TNF-α are considerably higher than in naive animals as aresult of the ongoing systemic inflammatory process. In these diseasedanimals, the TNF-α molecules are most likely being bound and neutralizedby soluble TNFR:Fc protein molecules and cannot be detected in thebioassay.

Example 7 rAAV Vector for Co-delivery of TNF Antagonist and IL-1Antagonist

A polynucleotide encoding a TNFR:Fc polypeptide (as described herein) iscloned into an rAAV vector plasmid as described in Example 2 to generatean rAAVTNFR:Fc plasmid. A polynucleotide encoding an IL-1R, GenBankentry U74649, is cloned into the rAAVTNFR:Fc plasmid. Both the TNFR:Fcencoding sequence and the IL-1R encoding sequence are operably linked totranscriptional regulatory sequences and both are enclosed between theAAV ITRs. This rAAV vector plasmid is denoted pAAVTNFR:FcIL-1R.

rAAV producer cell lines are generated by transfection of cells with thepAAVTNFR:FcIL-1R plasmid as described in Example 2. rAAV vectorparticles are prepared as described herein. Expression of TNFR:Fcactivity and of IL-1R activity after transduction of cells withrAAVTNFR:FcIL-1R viral particles is assessed using methods describedherein. An IL-1 bioassay is described in Kuiper et al., 1998.

The effect of administration of rAAVTNFR:FcIL-1R viral particles isassessed in the context of a animal arthritis model. rAAV viralparticles are administered by different routes includingintra-articular, intramuscular and intravenous injections. Assessment oftreatment includes determination of inflammation and cartilagedestruction in the joints.

1-39. (canceled)
 40. A method for treating arthritis in a mammal,comprising administering by intra-articular injection to an arthriticjoint of the mammal a recombinant adeno-associated virus (rAAV) vectorcomprising a polynucleotide encoding a fusion polypeptide comprising anextracellular domain of tumor necrosis factor receptor (TNFR) and aconstant domain of an IgG1 molecule, in conjunction with administrationof a polypeptide TNF antagonist.
 41. The method of claim 40, wherein therAAV vector is administered by injection to connective tissue selectedfrom the group consisting of a synovium, a cartilage, a ligament, and atendon of the mammal.
 42. The method of claim 40, wherein the rAAVvector is administered to synovial cells lining a joint space of themammal.
 43. The method of claim 40, wherein the TNFR extracellulardomain is from p75 TNFR.
 44. The method of claim 40, wherein thepolynucleotide encoding the TNFR polypeptide is operably linked to aheterologous promoter.
 45. The method of claim 40, wherein thepolynucleotide encoding the TNFR polypeptide is operably linked to aconstitutive promoter.
 46. The method of claim 40, wherein thepolynucleotide encoding the TNFR polypeptide is operably linked to aninducible promoter.
 47. The method of claim 46, wherein the induciblepromoter is from the TNFα gene.
 48. The method of claim 40, wherein thepolynucleotide further encodes a polypeptide comprising an interleukin-1(IL-1) antagonist.
 49. The method of claim 48, wherein the IL-1antagonist is an IL-1 receptor polypeptide, wherein said IL-1 receptorpolypeptide binds IL-1.
 50. The method of claim 49, wherein the IL-1receptor polypeptide is a IL-1 receptor type II polypeptide.
 51. Themethod of claim 40, wherein the TNF antagonist is a polypeptidecomprises extracellular domain of TNFR.
 52. The method of claim 40,wherein the TNF antagonist is an anti-TNF antibody.
 53. The method ofclaim 40, wherein the mammal is a human.
 54. A method for treatingarthritis in a mammal, comprising administering by intra-articularinjection to an arthritic joint of the mammal a recombinantadeno-associated virus (rAAV) vector comprising a polynucleotideencoding a fusion polypeptide comprising an extracellular domain oftumor necrosis factor receptor (TNFR) and a constant domain of an IgG1molecule, whereby arthritic condition in an uninjected contralateraljoint is treated.
 55. A method for treating arthritis in a mammal,comprising administering by intra-articular injection to an arthriticjoint of the mammal a recombinant adeno-associated virus (rAAV) vectorcomprising a polynucleotide encoding a fusion polypeptide comprising anextracellular domain of tumor necrosis factor receptor (TNFR) and aconstant domain of an IgG1 molecule, in conjunction with administrationof a polypeptide TNF antagonist whereby arthritic condition in anuninjected contralateral joint is treated.